Provider Demographics
NPI:1770532046
Name:SMITH, STEVEN L (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 N EL MOLINO AVE
Mailing Address - Street 2:#180
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1873
Mailing Address - Country:US
Mailing Address - Phone:626-792-1221
Mailing Address - Fax:626-792-0082
Practice Address - Street 1:131 N EL MOLINO AVE
Practice Address - Street 2:#180
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1873
Practice Address - Country:US
Practice Address - Phone:626-792-1221
Practice Address - Fax:626-792-0082
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC12544Medicare ID - Type Unspecified
DC12544Medicare PIN
CAT17383Medicare UPIN