Provider Demographics
NPI:1295766004
Name:SMOOKE CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:SMOOKE CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMOOKE
Authorized Official - Suffix:
Authorized Official - Credentials:SPOUSE
Authorized Official - Phone:412-422-4321
Mailing Address - Street 1:828 HAZELWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217
Mailing Address - Country:US
Mailing Address - Phone:412-422-4321
Mailing Address - Fax:412-422-2896
Practice Address - Street 1:828 HAZELWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217
Practice Address - Country:US
Practice Address - Phone:412-422-4321
Practice Address - Fax:412-422-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004209L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA8460650OtherCIGNA
PA1209146Medicaid
PA1042090Medicaid
PA4353872OtherAETNA
PA4353872OtherAETNA
PA608779Medicare ID - Type Unspecified