Provider Demographics
NPI:1861525339
Name:MILES, WARREN (LAC)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:MILES
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 1:1526A BLEYLER ST
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1118
Mailing Address - Country:US
Mailing Address - Phone:610-770-9476
Mailing Address - Fax:866-202-9017
Practice Address - Street 1:1624 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-4408
Practice Address - Country:US
Practice Address - Phone:610-770-9476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAKO000593171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist