=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023552353
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAY YRI-HALEN CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2016
-----------------------------------------------------
Last Update Date | 12/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12951 NE BEL RED RD STE 120
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98005-2628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-497-2107
-----------------------------------------------------
Fax | 425-455-2910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12951 NE BEL RED RD STE 120
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98005-2628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-497-2107
-----------------------------------------------------
Fax | 425-455-2910
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. JAY A YRI-HALEN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 425-497-2107
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NI0013X
-----------------------------------------------------
Taxonomy Name | Independent Medical Examiner Chiropractor
-----------------------------------------------------
License Number | CH0001239
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH0001239
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------