Healthcare Provider Details

I. General information

NPI: 1669665709
Provider Name (Legal Business Name): MILASICH CHIROPRACTIC PS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 6TH AVE
TACOMA WA
98406-2027
US

IV. Provider business mailing address

6615 6TH AVE
TACOMA WA
98406-2027
US

V. Phone/Fax

Practice location:
  • Phone: 253-565-2225
  • Fax:
Mailing address:
  • Phone: 253-565-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL L MILASICH
Title or Position: OWNER
Credential: D.C.
Phone: 253-565-2225