Provider Demographics
NPI:1629362041
Name:SMITH, JESSE DALTON (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:DALTON
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 1:1166 ESPLANADE
Mailing Address - Street 2:STE 2
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3361
Mailing Address - Country:US
Mailing Address - Phone:530-809-2695
Mailing Address - Fax:530-645-1835
Practice Address - Street 1:1166 ESPLANADE
Practice Address - Street 2:STE 2
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3361
Practice Address - Country:US
Practice Address - Phone:530-809-2695
Practice Address - Fax:530-645-1835
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor