Provider Demographics
NPI:1609760453
Name:SMITH, LEVI (AOBTA - CP)
Entity type:Individual
Prefix:
First Name:LEVI
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:AOBTA - CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-6353
Mailing Address - Country:US
Mailing Address - Phone:509-981-9616
Mailing Address - Fax:
Practice Address - Street 1:13607 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0809
Practice Address - Country:US
Practice Address - Phone:509-928-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002591171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty