Provider Demographics
NPI:1023552353
Name:JAY YRI-HALEN CHIROPRACTIC
Entity Type:Organization
Organization Name:JAY YRI-HALEN CHIROPRACTIC
Other - Org Name:JAY HALEN CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:YRI-HALEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-497-2107
Mailing Address - Street 1:12951 NE BEL RED RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2628
Mailing Address - Country:US
Mailing Address - Phone:425-497-2107
Mailing Address - Fax:425-455-2910
Practice Address - Street 1:12951 NE BEL RED RD STE 120
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2628
Practice Address - Country:US
Practice Address - Phone:425-497-2107
Practice Address - Fax:425-455-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0001239111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA15379OtherLABOR AND INDUSTRIES
WA15379OtherLABOR AND INDUSTRIES