Provider Demographics
NPI:1407320047
Name:SMITH, SHAIN NICOLAI (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAIN
Middle Name:NICOLAI
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 1:9476 DOUBLE R BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-2959
Mailing Address - Country:US
Mailing Address - Phone:775-284-3333
Mailing Address - Fax:
Practice Address - Street 1:3005 ETHELINDA WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-4426
Practice Address - Country:US
Practice Address - Phone:775-830-1613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor