Provider Demographics
NPI:1083649396
Name:SMITH, CHRISTINE SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:SUE
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 1:1017 FREMONT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3224
Mailing Address - Country:US
Mailing Address - Phone:626-441-4888
Mailing Address - Fax:626-441-5680
Practice Address - Street 1:1017 FREMONT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3224
Practice Address - Country:US
Practice Address - Phone:626-441-4888
Practice Address - Fax:626-441-5680
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05199ZOtherBLUE SHIELD
CAZZZ05199ZOtherBLUE SHIELD
CAW16390Medicare ID - Type UnspecifiedGROUP PROVIDER ID