Provider Demographics
NPI:1083296289
Name:MILO, BLAIR MADLAND (DC)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:MADLAND
Last Name:MILO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E 15TH ST APT C
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-5365
Mailing Address - Country:US
Mailing Address - Phone:706-817-2691
Mailing Address - Fax:
Practice Address - Street 1:3151 AIRWAY AVE STE U3
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4627
Practice Address - Country:US
Practice Address - Phone:714-754-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor