Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH00000843 | WA |
NPI | 1710008180 |
---|---|
Provider Name | Dr. Dennis Dewayne Byam |
First Address | Grandview, WA 98930-1358 |
Second Address | Grandview, WA 98930-1358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2093201 | (05) | WA |
T02053 | (02) | WA |