Provider Demographics
NPI:1710927876
Name:SMITH, SIRI R (DC)
Entity Type:Individual
Prefix:DR
First Name:SIRI
Middle Name:R
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 1:30 E 60TH ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1008
Mailing Address - Country:US
Mailing Address - Phone:212-737-9000
Mailing Address - Fax:212-223-5700
Practice Address - Street 1:30 E. 60TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-737-9000
Practice Address - Fax:212-223-5700
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27863111N00000X
NYX003158-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0278630OtherBS
CAWDC27863AMedicare ID - Type Unspecified