Provider Demographics
NPI:1346269057
Name:SMITH, CYNTHIA D (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 DOVER DR.
Mailing Address - Street 2:SUITE 17
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-5993
Mailing Address - Country:US
Mailing Address - Phone:949-524-3235
Mailing Address - Fax:818-922-8913
Practice Address - Street 1:833 DOVER DR.
Practice Address - Street 2:SUITE 17
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-5993
Practice Address - Country:US
Practice Address - Phone:949-524-3235
Practice Address - Fax:818-922-8913
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3679111N00000X
CA15819171100000X
CA33261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO487068Medicare PIN
COU53319Medicare UPIN