Provider Demographics
NPI:1952504888
Name:BLYMYER, WENDY (DC)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:BLYMYER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1721
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0045
Mailing Address - Country:US
Mailing Address - Phone:541-412-8919
Mailing Address - Fax:
Practice Address - Street 1:610 5TH ST STE C
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9199
Practice Address - Country:US
Practice Address - Phone:541-412-8919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3534111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR16-1713953Medicare UPIN
ORR 130889Medicare ID - Type UnspecifiedMEDICARE #