Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CH943 | WA |
NPI | 1245317213 |
---|---|
Provider Name | Michael Lucas Milasich |
First Address | Tacoma, WA 98406-2027 |
Second Address | Tacoma, WA 98406-2027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 03/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
601893662 | (02) |