Provider Demographics
NPI:1245375526
Name:SMITH, TODD JACOB (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:JACOB
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 1:1633 BIRCHWOOD AVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-9220
Mailing Address - Country:US
Mailing Address - Phone:360-527-3668
Mailing Address - Fax:360-527-3668
Practice Address - Street 1:1633 BIRCHWOOD AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-9220
Practice Address - Country:US
Practice Address - Phone:360-527-3668
Practice Address - Fax:360-527-3668
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB20007Medicare ID - Type Unspecified