Provider Demographics
NPI:1295450336
Name:KELLY BRETT SMITH CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:KELLY BRETT SMITH CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-678-4070
Mailing Address - Street 1:2123 S HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5269
Mailing Address - Country:US
Mailing Address - Phone:520-459-5199
Mailing Address - Fax:520-459-1303
Practice Address - Street 1:2123 S HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5269
Practice Address - Country:US
Practice Address - Phone:520-459-5199
Practice Address - Fax:520-459-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty