Provider Demographics
NPI:1609161454
Name:SMITH, ANTHONY SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:SCOTT
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5687 WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1129
Mailing Address - Country:US
Mailing Address - Phone:562-866-8384
Mailing Address - Fax:562-920-1454
Practice Address - Street 1:5687 WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1129
Practice Address - Country:US
Practice Address - Phone:562-866-8384
Practice Address - Fax:562-920-1454
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31520111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician