Provider Demographics
NPI:1700262037
Name:SMARTSPEIDEL LLC
Entity type:Organization
Organization Name:SMARTSPEIDEL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-779-5580
Mailing Address - Street 1:19586 10TH AVE NE
Mailing Address - Street 2:STE 100
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7332
Mailing Address - Country:US
Mailing Address - Phone:360-779-5580
Mailing Address - Fax:360-697-4617
Practice Address - Street 1:19586 10TH AVE NE
Practice Address - Street 2:STE 100
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7332
Practice Address - Country:US
Practice Address - Phone:360-779-5580
Practice Address - Fax:360-697-4617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034623111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty