Provider Demographics
NPI:1801825526
Name:MILAM, BRYCE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:
Last Name:MILAM
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 1:11125 NE SANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2555
Mailing Address - Country:US
Mailing Address - Phone:503-257-3377
Mailing Address - Fax:503-257-3432
Practice Address - Street 1:11125 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-2555
Practice Address - Country:US
Practice Address - Phone:503-257-3377
Practice Address - Fax:503-257-3432
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR271827111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT67919Medicare UPIN
ORR114313Medicare ID - Type Unspecified