Provider Demographics
NPI:1366451544
Name:SMITH, PERRY (DC)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 MISSION AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-1815
Mailing Address - Country:US
Mailing Address - Phone:760-433-8641
Mailing Address - Fax:760-433-9152
Practice Address - Street 1:3815 MISSION AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1815
Practice Address - Country:US
Practice Address - Phone:760-433-8641
Practice Address - Fax:760-433-9152
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC15393Medicare UPIN
CADC15393Medicare ID - Type Unspecified