Provider Demographics
NPI:1073796710
Name:SMITH, ROECHELLE LAVETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROECHELLE
Middle Name:LAVETTE
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 1:2101 S BLACKHAWK ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1492
Mailing Address - Country:US
Mailing Address - Phone:303-337-1321
Mailing Address - Fax:303-337-2305
Practice Address - Street 1:2101 S BLACKHAWK ST
Practice Address - Street 2:SUITE 140
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1492
Practice Address - Country:US
Practice Address - Phone:303-337-1321
Practice Address - Fax:303-337-2305
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor