Provider Demographics
NPI:1760661920
Name:SMITH, JOSEPH PHILLIP (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PHILLIP
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 1:85 BOLINAS RD STE 2
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1626
Mailing Address - Country:US
Mailing Address - Phone:415-459-4411
Mailing Address - Fax:415-226-0450
Practice Address - Street 1:85 BOLINAS RD STE 2
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930
Practice Address - Country:US
Practice Address - Phone:415-459-4411
Practice Address - Fax:415-226-0450
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29581111N00000X
ND761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDSMI 25763OtherBLUE CROSS BLUE SHIELD