Provider Demographics
NPI:1093895922
Name:NELSON-SMEATON, JEANIE M (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANIE
Middle Name:M
Last Name:NELSON-SMEATON
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 1:1454 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-1944
Mailing Address - Country:US
Mailing Address - Phone:559-897-3285
Mailing Address - Fax:
Practice Address - Street 1:1454 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-1944
Practice Address - Country:US
Practice Address - Phone:559-897-3285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0166480Medicaid
CA6773833Medicare UPIN
CADC0166480Medicare ID - Type Unspecified
CADC0166480Medicaid