Provider Demographics
NPI:1780206243
Name:SMITH, KIERRA M
Entity Type:Individual
Prefix:
First Name:KIERRA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 NE 205TH ST APT 507
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1017
Mailing Address - Country:US
Mailing Address - Phone:706-238-0269
Mailing Address - Fax:
Practice Address - Street 1:19720 68TH AVE W STE B
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4568
Practice Address - Country:US
Practice Address - Phone:425-673-4161
Practice Address - Fax:425-673-4164
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61116941111N00000X
GACHIR010358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor