Provider Demographics
NPI:1649795956
Name:SMITH, NIQUISHEILA TAKIA
Entity type:Individual
Prefix:
First Name:NIQUISHEILA
Middle Name:TAKIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 RIPPLING BROOK TRCE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-1828
Mailing Address - Country:US
Mailing Address - Phone:678-365-7278
Mailing Address - Fax:888-505-3765
Practice Address - Street 1:390 RIPPLING BROOK TRCE
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268-1828
Practice Address - Country:US
Practice Address - Phone:678-365-7278
Practice Address - Fax:888-505-3765
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009853111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor