Provider Demographics
NPI:1609255157
Name:SMITH-ELLIOTT, TALITHA (DC)
Entity Type:Individual
Prefix:
First Name:TALITHA
Middle Name:
Last Name:SMITH-ELLIOTT
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 1:1900 LAMY LN STE D
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-9200
Mailing Address - Country:US
Mailing Address - Phone:318-355-2587
Mailing Address - Fax:
Practice Address - Street 1:1900 LAMY LN STE D
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-9200
Practice Address - Country:US
Practice Address - Phone:318-355-2587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor