Provider Demographics
NPI:1295006518
Name:JAMIE J SMITH CHIROPRACTIC INC
Entity Type:Organization
Organization Name:JAMIE J SMITH CHIROPRACTIC INC
Other - Org Name:SMITH CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, DC
Authorized Official - Phone:530-547-3787
Mailing Address - Street 1:9384 DESCHUTES RD
Mailing Address - Street 2:STE E
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073-8754
Mailing Address - Country:US
Mailing Address - Phone:530-547-3787
Mailing Address - Fax:530-547-4979
Practice Address - Street 1:9384 DESCHUTES RD
Practice Address - Street 2:STE E
Practice Address - City:PALO CEDRO
Practice Address - State:CA
Practice Address - Zip Code:96073-8754
Practice Address - Country:US
Practice Address - Phone:530-547-3787
Practice Address - Fax:530-547-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU47154Medicare UPIN