Provider Demographics
NPI:1013032721
Name:SMITH CHIROPRACTIC
Entity Type:Organization
Organization Name:SMITH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-792-1221
Mailing Address - Street 1:131 N EL MOLINO AVE
Mailing Address - Street 2:#180
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1873
Mailing Address - Country:US
Mailing Address - Phone:626-792-1221
Mailing Address - Fax:626-792-0082
Practice Address - Street 1:131 N EL MOLINO AVE
Practice Address - Street 2:#180
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1873
Practice Address - Country:US
Practice Address - Phone:626-792-1221
Practice Address - Fax:626-792-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC12544Medicare ID - Type UnspecifiedSTATE LICENSE