Provider Demographics
NPI:1366841264
Name:SMART BODY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SMART BODY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CARLYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-847-2248
Mailing Address - Street 1:372 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1777
Mailing Address - Country:US
Mailing Address - Phone:401-847-2248
Mailing Address - Fax:401-847-5915
Practice Address - Street 1:372 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-1777
Practice Address - Country:US
Practice Address - Phone:401-847-2248
Practice Address - Fax:401-847-5915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty