Provider Demographics
NPI:1992767248
Name:MILANOVICH, PETER J (DC, LPT)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:MILANOVICH
Suffix:
Gender:M
Credentials:DC, LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16679 SW 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 SW BOONES FERRY RD.
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4378
Practice Address - Country:US
Practice Address - Phone:503-635-6005
Practice Address - Fax:503-635-6016
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-1590111N00000X
OR0564225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist