Provider Demographics
NPI:1245392125
Name:NYREN, CARL M (DC)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:M
Last Name:NYREN
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:10828 GRAVELLY LK DR SW
Mailing Address - Street 2:SUITE #108
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1334
Mailing Address - Country:US
Mailing Address - Phone:253-588-9731
Mailing Address - Fax:253-588-9731
Practice Address - Street 1:10828 GRAVELLY LK DR SW
Practice Address - Street 2:SUITE #108
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1334
Practice Address - Country:US
Practice Address - Phone:253-588-9731
Practice Address - Fax:253-588-9731
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA2206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA57407OtherDEPT OF LABOR INDUSTRIES
NY4481Medicare UPIN