Provider Demographics
NPI:1013932201
Name:SMITH, DENNIS E (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 19TH ST W
Mailing Address - Street 2:#11
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6223
Mailing Address - Country:US
Mailing Address - Phone:253-267-8188
Mailing Address - Fax:253-267-8187
Practice Address - Street 1:6314 19TH ST W
Practice Address - Street 2:#11
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6223
Practice Address - Country:US
Practice Address - Phone:253-267-8188
Practice Address - Fax:253-267-8187
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001762111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA32024OtherSTATE LABOR & INDUSTRIES
WA350055487OtherRAILROAD MEDICARE
WASM3685OtherREGENCE
WA8647406Medicaid
WAG8852620OtherMEDICARE PTAN
WA1013932201Medicare UPIN