Provider Demographics
NPI:1184705857
Name:SMITH, THOMAS ERIC (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ERIC
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 1:550 WATER ST
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4124
Mailing Address - Country:US
Mailing Address - Phone:831-426-6450
Mailing Address - Fax:831-426-0418
Practice Address - Street 1:550 WATER ST
Practice Address - Street 2:BUILDING C
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4124
Practice Address - Country:US
Practice Address - Phone:831-426-6450
Practice Address - Fax:831-426-0418
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16877111N00000X, 111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT06293Medicare UPIN
CADC0168770Medicare ID - Type Unspecified