Provider Demographics
NPI:1235164518
Name:SMITH, STEPHEN W (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:WADE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:8821 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620
Mailing Address - Country:US
Mailing Address - Phone:714-527-3332
Mailing Address - Fax:714-527-3313
Practice Address - Street 1:8821 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620
Practice Address - Country:US
Practice Address - Phone:714-527-3332
Practice Address - Fax:714-527-3313
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor