Provider Demographics
NPI:1770822900
Name:SMITH, RYAN CRAIG (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CRAIG
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 1:6621 E PACIFIC COAST HWY
Mailing Address - Street 2:STE 120
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4244
Mailing Address - Country:US
Mailing Address - Phone:562-414-5001
Mailing Address - Fax:562-414-5002
Practice Address - Street 1:6621 E PACIFIC COAST HWY
Practice Address - Street 2:STE 120
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4244
Practice Address - Country:US
Practice Address - Phone:562-414-5001
Practice Address - Fax:562-414-5002
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2019-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor