Provider Demographics
NPI:1790940617
Name:SMITH SPINAL CENTER LLC
Entity Type:Organization
Organization Name:SMITH SPINAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:504-301-4231
Mailing Address - Street 1:2709 ATHANIA PKWY
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5903
Mailing Address - Country:US
Mailing Address - Phone:504-301-4231
Mailing Address - Fax:504-301-4253
Practice Address - Street 1:2709 ATHANIA PKWY
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5903
Practice Address - Country:US
Practice Address - Phone:504-301-4231
Practice Address - Fax:504-301-4253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty