Provider Demographics
NPI:1912600164
Name:SMITH, DESIREE J (DC)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WINTON RD S
Mailing Address - Street 2:BLDG 3 STE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3970
Mailing Address - Country:US
Mailing Address - Phone:585-440-4901
Mailing Address - Fax:585-448-0054
Practice Address - Street 1:2000 WINTON RD S
Practice Address - Street 2:BLDG 3 STE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3970
Practice Address - Country:US
Practice Address - Phone:585-440-4901
Practice Address - Fax:585-448-0054
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor