Provider Demographics
NPI:1821265760
Name:SMITH, CARLY M (DC)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:M
Other - Last Name:ZILLIGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7716 W. NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PK
Mailing Address - State:IL
Mailing Address - Zip Code:60707
Mailing Address - Country:US
Mailing Address - Phone:708-456-8844
Mailing Address - Fax:708-456-5550
Practice Address - Street 1:7716 W. NORTH
Practice Address - Street 2:
Practice Address - City:ELMWOOD PK
Practice Address - State:IL
Practice Address - Zip Code:60707
Practice Address - Country:US
Practice Address - Phone:708-456-8844
Practice Address - Fax:708-456-5550
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-011174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor