Provider Demographics
NPI:1477739860
Name:SMURTHWAITE, MARCY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCY
Middle Name:
Last Name:SMURTHWAITE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12855 S BELCHER RD.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-1638
Mailing Address - Country:US
Mailing Address - Phone:727-539-0075
Mailing Address - Fax:727-538-2663
Practice Address - Street 1:12855 S BELCHER RD.
Practice Address - Street 2:SUITE 1
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1638
Practice Address - Country:US
Practice Address - Phone:727-539-0075
Practice Address - Fax:727-538-2663
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCHOOO 4192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT85434Medicare UPIN