Provider Demographics
NPI:1689717183
Name:SMITH, ALYS OLIVIA (DC)
Entity Type:Individual
Prefix:DR
First Name:ALYS
Middle Name:OLIVIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ALYS
Other - Middle Name:OLIVIA
Other - Last Name:PIRTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:509 OLIVE WAY
Mailing Address - Street 2:SUITE 1342
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1720
Mailing Address - Country:US
Mailing Address - Phone:206-682-1460
Mailing Address - Fax:206-467-1453
Practice Address - Street 1:509 OLIVE WAY
Practice Address - Street 2:SUITE 1342
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1720
Practice Address - Country:US
Practice Address - Phone:206-682-1460
Practice Address - Fax:206-467-1453
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8869430OtherMEDICARE
WA0240729OtherLABOR AND INDUSTRIES