Provider Demographics
NPI:1982688545
Name:BLYSS, GRETCHEN KARIN (BA, DC)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:KARIN
Last Name:BLYSS
Suffix:
Gender:F
Credentials:BA, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SW COLUMBIA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5848
Mailing Address - Country:US
Mailing Address - Phone:503-222-0551
Mailing Address - Fax:503-224-9619
Practice Address - Street 1:111 SW COLUMBIA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5848
Practice Address - Country:US
Practice Address - Phone:503-222-0551
Practice Address - Fax:503-224-9619
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR713587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor