Provider Demographics
NPI:1851063341
Name:SMITH, ELIZABETH (ND, LAC, LMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:ND, LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2146 NE 4TH ST STE 160
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3618
Mailing Address - Country:US
Mailing Address - Phone:907-317-8437
Mailing Address - Fax:
Practice Address - Street 1:2146 NE 4TH ST STE 160
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3618
Practice Address - Country:US
Practice Address - Phone:541-306-4471
Practice Address - Fax:541-566-7493
Is Sole Proprietor?:No
Enumeration Date:2021-10-02
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC209012171100000X
OR26825225700000X
AL5752225700000X
OR4421175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist