Provider Demographics
NPI:1558484352
Name:BLYE, JOHN S (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:BLYE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6226 196TH ST SW
Mailing Address - Street 2:SUITE 1-D
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5959
Mailing Address - Country:US
Mailing Address - Phone:425-775-4533
Mailing Address - Fax:425-775-4534
Practice Address - Street 1:6226 196TH ST SW
Practice Address - Street 2:SUITE 1-D
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5959
Practice Address - Country:US
Practice Address - Phone:425-775-4533
Practice Address - Fax:425-775-4534
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA1076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA001200062GMedicare PIN