Provider Demographics
NPI:1902058233
Name:AYALA, JOSEPH C (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:AYALA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:GIRMA
Other - Middle Name:C
Other - Last Name:AYALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:12901 SE KENT KANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7939
Mailing Address - Country:US
Mailing Address - Phone:253-630-1575
Mailing Address - Fax:253-630-4650
Practice Address - Street 1:12901 SE KENT KANGLEY RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7939
Practice Address - Country:US
Practice Address - Phone:253-630-1575
Practice Address - Fax:253-630-4650
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003391111N00000X
CO6221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor