Provider Demographics
NPI:1124206321
Name:SMITH, JOSEPHINE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:
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 1:1211 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3907
Mailing Address - Country:US
Mailing Address - Phone:707-527-0232
Mailing Address - Fax:707-978-2260
Practice Address - Street 1:1211 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3907
Practice Address - Country:US
Practice Address - Phone:707-527-0232
Practice Address - Fax:707-978-2260
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADCO19610111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADCO196100Medicare PIN