Provider Demographics
NPI:1578120002
Name:HEIDI SMITH CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:HEIDI SMITH CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-850-9566
Mailing Address - Street 1:510 N PROSPECT AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3032
Mailing Address - Country:US
Mailing Address - Phone:310-376-5433
Mailing Address - Fax:
Practice Address - Street 1:510 N PROSPECT AVE STE 207
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3032
Practice Address - Country:US
Practice Address - Phone:310-376-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699077255OtherNPI ENUMERATOR