Provider Demographics
NPI:1316203540
Name:BODY SMITH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BODY SMITH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-216-4416
Mailing Address - Street 1:1818 WESTLAKE AVE. N
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2707
Mailing Address - Country:US
Mailing Address - Phone:206-216-4416
Mailing Address - Fax:206-216-4417
Practice Address - Street 1:1818 WESTLAKE AVE N
Practice Address - Street 2:STE 330
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2777
Practice Address - Country:US
Practice Address - Phone:206-216-4416
Practice Address - Fax:206-216-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033924305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization