Provider Demographics
NPI:1558738526
Name:SMITH, ALICIA (DC)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
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 1:3300 SW HOCKEN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005
Mailing Address - Country:US
Mailing Address - Phone:503-744-5772
Mailing Address - Fax:503-325-9135
Practice Address - Street 1:3300 SW HOCKEN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2444
Practice Address - Country:US
Practice Address - Phone:503-744-5772
Practice Address - Fax:503-325-9135
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500769229Medicaid