Provider Demographics
NPI:1306280532
Name:MILES, SAMUEL FORREST (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:FORREST
Last Name:MILES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7160 MOON ROAD
Mailing Address - Street 2:SUITE G
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909
Mailing Address - Country:US
Mailing Address - Phone:706-507-4000
Mailing Address - Fax:706-221-5533
Practice Address - Street 1:7160 MOON ROAD
Practice Address - Street 2:SUITE G
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909
Practice Address - Country:US
Practice Address - Phone:706-507-4000
Practice Address - Fax:706-221-5533
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009182111N00000X
TN00000000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGOtherPENDING