Provider Demographics
NPI:1972559466
Name:SMALLIE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:SMALLIE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SMALLIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-957-9601
Mailing Address - Street 1:2027 GRAND CANAL BLVD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6650
Mailing Address - Country:US
Mailing Address - Phone:209-957-9601
Mailing Address - Fax:209-956-6808
Practice Address - Street 1:2027 GRAND CANAL BLVD
Practice Address - Street 2:SUITE 21
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6650
Practice Address - Country:US
Practice Address - Phone:209-957-9601
Practice Address - Fax:209-956-6808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25325ZMedicare ID - Type Unspecified
CAZZZ32003ZMedicare ID - Type Unspecified