Provider Demographics
NPI:1316399736
Name:STAN SMITH CHIROPRACTIC,A CALIFORNIA PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:STAN SMITH CHIROPRACTIC,A CALIFORNIA PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-725-0101
Mailing Address - Street 1:8421 AUBURN BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-0359
Mailing Address - Country:US
Mailing Address - Phone:916-725-0101
Mailing Address - Fax:916-725-0906
Practice Address - Street 1:8421 AUBURN BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-0359
Practice Address - Country:US
Practice Address - Phone:916-725-0101
Practice Address - Fax:916-725-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-09
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0123130Medicare PIN