Provider Demographics
NPI:1083849053
Name:SMITH CHIROPRACTIC CLINIC OF BLUE WATER AREA, PLLC
Entity Type:Organization
Organization Name:SMITH CHIROPRACTIC CLINIC OF BLUE WATER AREA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:CATHLEEN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-982-0730
Mailing Address - Street 1:1009 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3729
Mailing Address - Country:US
Mailing Address - Phone:810-982-0730
Mailing Address - Fax:810-982-0148
Practice Address - Street 1:1009 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3729
Practice Address - Country:US
Practice Address - Phone:810-982-0730
Practice Address - Fax:810-982-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty