Provider Demographics
NPI:1093847527
Name:SMITH, TAMARA DAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:DAWN
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 1:2224B SANDALWOOD RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1322
Mailing Address - Country:US
Mailing Address - Phone:757-275-4198
Mailing Address - Fax:
Practice Address - Street 1:2260 SEASHORE SHOPPES
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1364
Practice Address - Country:US
Practice Address - Phone:757-275-4198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3407111N00000X
VA0104556455111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCV08102Medicare UPIN