Provider Demographics
NPI:1346386406
Name:SMITH, SCOTT K (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:K
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1520 3RD ST NW STE E
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-1957
Mailing Address - Country:US
Mailing Address - Phone:406-866-0101
Mailing Address - Fax:406-866-0121
Practice Address - Street 1:2191 S EL CAMINO REAL
Practice Address - Street 2:#105
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6224
Practice Address - Country:US
Practice Address - Phone:760-754-2225
Practice Address - Fax:760-754-2256
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19611111N00000X
MT590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU24370Medicare UPIN