Provider Demographics
NPI:1609866623
Name:SMITH, JANICE VARGA (DC)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:VARGA
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 1:412 WILBAR CIR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-6352
Mailing Address - Country:US
Mailing Address - Phone:909-553-4449
Mailing Address - Fax:909-784-1836
Practice Address - Street 1:370 ALABAMA ST
Practice Address - Street 2:SUITE A
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8044
Practice Address - Country:US
Practice Address - Phone:909-553-4449
Practice Address - Fax:909-784-1836
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV07064Medicare UPIN
CADC0298850Medicare PIN