Provider Demographics
NPI:1568672392
Name:AYRES, JOHN RICHARD (DC, DABCO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:AYRES
Suffix:
Gender:M
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 100TH PL SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3864
Mailing Address - Country:US
Mailing Address - Phone:425-338-1404
Mailing Address - Fax:425-338-1406
Practice Address - Street 1:1819 100TH PL SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3864
Practice Address - Country:US
Practice Address - Phone:425-338-1404
Practice Address - Fax:425-338-1406
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor