Provider Demographics
NPI:1396815742
Name:YRI-HALEN, JAY A (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:A
Last Name:YRI-HALEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JAY
Other - Middle Name:A
Other - Last Name:HALEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA910990339OtherTAX ID #
WA0015379OtherL&I PROVIDER #
WA600222041OtherUBI #
WACH00001239OtherWA STATE LICENSE #
WA0181959OtherL&I IME PROVIDER #
WA600222041OtherUBI #