Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | X0064451 | NY |
NPI | 1598880478 |
---|---|
Provider Name | Miles Ralph Wiltse |
First Address | East Syracuse, NY 13057-1600 |
Second Address | East Syracuse, NY 13057-1600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C064453 | WORKERS COMPENSATION (01) | NY |