Provider Demographics
NPI:1518082106
Name:SMITH, KAREN SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:SUE
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 1:22015 STATE ROUTE 410 E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-4241
Mailing Address - Country:US
Mailing Address - Phone:253-891-9109
Mailing Address - Fax:253-826-0438
Practice Address - Street 1:22015 STATE ROUTE 410 E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-4241
Practice Address - Country:US
Practice Address - Phone:253-891-9109
Practice Address - Fax:253-826-0438
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA99514OtherW.C. & L&I ID NUMBER
WA4168THOtherOTHER INSURANCE NUMBER
WA8853343Medicare ID - Type UnspecifiedMEDICARE GRP. NUMBER
WAU89992Medicare UPIN
WA8853345Medicare ID - Type UnspecifiedMEDICARE ID NUMBER