Provider Demographics
NPI:1154353886
Name:MILEY, JOHN P (LAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:MILEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 W SAINT GERMAIN ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4502
Mailing Address - Country:US
Mailing Address - Phone:320-656-1010
Mailing Address - Fax:
Practice Address - Street 1:816 W SAINT GERMAIN ST
Practice Address - Street 2:STE. 201
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4502
Practice Address - Country:US
Practice Address - Phone:320-656-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1129171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist