Provider Demographics
NPI:1659886778
Name:SMESTAD, JUSTIN LEE (DC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LEE
Last Name:SMESTAD
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 1:218 S SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2102
Mailing Address - Country:US
Mailing Address - Phone:970-218-5634
Mailing Address - Fax:
Practice Address - Street 1:218 S SUNSET ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2102
Practice Address - Country:US
Practice Address - Phone:970-218-5634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor