Provider Demographics
NPI:1023057601
Name:SMALLIE, DON DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:DON
Middle Name:DAVID
Last Name:SMALLIE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32003ZMedicare ID - Type Unspecified