Healthcare Provider Details

I. General information

NPI: 1396815742
Provider Name (Legal Business Name): JAY A. YRI-HALEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAY A. HALEN D.C.

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12951 NE BEL RED RD STE 120
BELLEVUE WA
98005-2628
US

IV. Provider business mailing address

12951 NE BEL RED RD STE 120
BELLEVUE WA
98005-2628
US

V. Phone/Fax

Practice location:
  • Phone: 425-497-2107
  • Fax: 425-455-2910
Mailing address:
  • Phone: 425-497-2107
  • Fax: 425-455-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00001239
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: