Provider Demographics
NPI:1497029359
Name:SMITH, STEPHANIE LOUISE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LOUISE
Last Name:SMITH
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 1:1675 ROSWELL RD
Mailing Address - Street 2:APT. 233
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3662
Mailing Address - Country:US
Mailing Address - Phone:845-325-6596
Mailing Address - Fax:
Practice Address - Street 1:1000 CONCORD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4206
Practice Address - Country:US
Practice Address - Phone:770-438-8990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor