Provider Demographics
NPI:1205075769
Name:MILANOVICH CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MILANOVICH CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MILANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-635-6005
Mailing Address - Street 1:16679 BOONES FERRY RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4378
Mailing Address - Country:US
Mailing Address - Phone:503-635-6005
Mailing Address - Fax:503-635-6016
Practice Address - Street 1:16679 BOONES FERRY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4365
Practice Address - Country:US
Practice Address - Phone:503-635-6005
Practice Address - Fax:503-635-6016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty