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General NPI Number Information
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NPI Number | 1982688545
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Entity Type | Individual
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Provider Name | GRETCHEN KARIN BLYSS BA, DC
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Gender | Female
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 02/14/2011
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Provider Practice Location Address
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Address Line | 111 SW COLUMBIA ST SUITE 100
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City | PORTLAND
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State | OR
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Zip | 97201-5848
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Country | US
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Telephone | 503-222-0551
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Fax | 503-224-9619
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Provider Business Mailing Address
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Address Line | 111 SW COLUMBIA ST SUITE 100
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City | PORTLAND
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State | OR
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Zip | 97201-5848
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Country | US
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Telephone | 503-222-0551
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Fax | 503-224-9619
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 713587
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License Number State | OR
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