Provider Demographics
NPI:1063417186
Name:BLESSLEY, MARK J (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:BLESSLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3219
Mailing Address - Country:US
Mailing Address - Phone:360-693-7781
Mailing Address - Fax:360-693-1688
Practice Address - Street 1:204 E 25TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3219
Practice Address - Country:US
Practice Address - Phone:360-693-7781
Practice Address - Fax:360-693-1688
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR27136111N00000X
WACH00003457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA350055943OtherRAILROAD MEDICARE
WA8370819Medicaid
WA0154880OtherDEPT. OF LABOR & IND
WAAB26888Medicare ID - Type Unspecified
WA8370819Medicaid