Provider Demographics
NPI:1598181265
Name:SMYTH, MARK A (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:SMYTH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6821 SWEETWATER WAY
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-5524
Mailing Address - Country:US
Mailing Address - Phone:805-275-1668
Mailing Address - Fax:805-981-2419
Practice Address - Street 1:6821 SWEETWATER WAY
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-5524
Practice Address - Country:US
Practice Address - Phone:805-275-1668
Practice Address - Fax:805-981-2419
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor