Provider Demographics
NPI:1205921491
Name:SMIRNOV, MARSHA (DC, FICPA)
Entity type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:
Last Name:SMIRNOV
Suffix:
Gender:F
Credentials:DC, FICPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 N ATLANTIC AVE STE C
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3226
Mailing Address - Country:US
Mailing Address - Phone:321-365-2965
Mailing Address - Fax:
Practice Address - Street 1:230 FORTENBERRY RD
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3619
Practice Address - Country:US
Practice Address - Phone:321-453-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30569111N00000X
FLCH14257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN851423200Medicaid