Provider Demographics
NPI:1538284310
Name:VIZNAUGH-MILTON, BRENDA M (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:M
Last Name:VIZNAUGH-MILTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:M
Other - Last Name:VIZNAUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:201 N ROCK ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-4339
Mailing Address - Country:US
Mailing Address - Phone:360-736-9906
Mailing Address - Fax:360-736-4963
Practice Address - Street 1:201 N ROCK ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4339
Practice Address - Country:US
Practice Address - Phone:360-736-9906
Practice Address - Fax:360-736-4963
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1861517666OtherGROUP NPI
WAV15405OtherREGENCE
WA8868983OtherPTAN
WA57586OtherL&I
WA000917209OtherGROUPS PTAN
WA8868983OtherPTAN
WA1861517666OtherGROUP NPI