Provider Demographics
NPI:1245338805
Name:SIMS, BRIAN BLAKE (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:BLAKE
Last Name:SIMS
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 1:4370 SE KING RD STE 220
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-1613
Mailing Address - Country:US
Mailing Address - Phone:503-654-7400
Mailing Address - Fax:503-654-1003
Practice Address - Street 1:4370 SE KING RD STE 220
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-1613
Practice Address - Country:US
Practice Address - Phone:503-654-7400
Practice Address - Fax:503-654-1003
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30134111N00000X
OR3930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500681336Medicaid