Provider Demographics
NPI:1548615610
Name:SMITH, ALYSE (DC)
Entity Type:Individual
Prefix:
First Name:ALYSE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1280 W PEACHTREE ST NW
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3445
Mailing Address - Country:US
Mailing Address - Phone:734-635-0767
Mailing Address - Fax:404-378-1551
Practice Address - Street 1:1280 W PEACHTREE ST NW
Practice Address - Street 2:SUITE 250
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3445
Practice Address - Country:US
Practice Address - Phone:734-635-0767
Practice Address - Fax:404-378-1551
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2021-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GACHIR009658111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor