Provider Demographics
NPI:1093715278
Name:SMITH, EMILY J (DC, DICCP)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC, DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 W CLAIREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6102
Mailing Address - Country:US
Mailing Address - Phone:715-833-3505
Mailing Address - Fax:715-833-8515
Practice Address - Street 1:829 W CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6102
Practice Address - Country:US
Practice Address - Phone:715-833-3505
Practice Address - Fax:715-833-8515
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3693-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38960000Medicaid
WI350050837OtherRAILROAD MEDICARE
WI392007133011OtherBLUE CROSS
WI350050837OtherRAILROAD MEDICARE
U82233Medicare UPIN