Provider Demographics
NPI:1053495804
Name:SMITH, CHERIE L (DC)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 N EL CAMINO REAL
Mailing Address - Street 2:SUITE C
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024
Mailing Address - Country:US
Mailing Address - Phone:760-479-0009
Mailing Address - Fax:760-479-0561
Practice Address - Street 1:274 N EL CAMINO REAL
Practice Address - Street 2:SUITE C
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-479-0009
Practice Address - Fax:760-479-0561
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29469Medicare ID - Type Unspecified
CAV03883Medicare UPIN