Individual
BLAKE BERT ROYLANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1342 S PIONEER WAY, MOSES LAKE, WA 98837-2410
(509) 855-6482
Mailing address
1342 S PIONEER WAY, MOSES LAKE, WA 98837-2410
(509) 855-6482
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH61024794
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CH61024794
INSURANCE
WA
Enumeration date
12/11/2019
Last updated
07/15/2022
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