Provider Demographics
NPI:1497275978
Name:SMART ENERGY HEALING LLC
Entity Type:Organization
Organization Name:SMART ENERGY HEALING LLC
Other - Org Name:SMART ENERGY HEALING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-689-6744
Mailing Address - Street 1:10909 CROCUS PL NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8003
Mailing Address - Country:US
Mailing Address - Phone:360-689-2128
Mailing Address - Fax:
Practice Address - Street 1:9119 RIDGETOP BLVD NW STE 160
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8549
Practice Address - Country:US
Practice Address - Phone:360-779-5580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034623111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty