MEDICARE: JAY YRI-HALEN CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NI0013X	Independent Medical Examiner Chiropractor	CH0001239	WA
2	111N00000X	Chiropractor	CH0001239	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15379	OTHER	WA	LABOR AND INDUSTRIES

General Provider Information

NPI Number	:	1023552353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY YRI-HALEN CHIROPRACTIC

Provider Business Mailing Address
First Line	:	12951 NE BEL RED RD STE 120
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98005-2628
Country	:	US
Telephone Number	:	425-497-2107
Fax Number	:	425-455-2910

Provider Business Practice Location Address
First Line	:	12951 NE BEL RED RD STE 120
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98005-2628
Country	:	US
Telephone Number	:	425-497-2107
Fax Number	:	425-455-2910

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. JAY A YRI-HALEN
Credential	:	D.C.
Telephone Number	:	425-497-2107

Provider Enumeration Date	:	12/06/2016
Last Update Date	:	12/06/2016

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