MEDICARE: DR. TAMARA DAWN SMITH D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3407	NC
2	111N00000X	Chiropractor	0104556455	VA

General Provider Information

NPI Number	:	1093847527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMARA DAWN SMITH D.C.

Provider Business Mailing Address
First Line	:	2224B SANDALWOOD RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1322
Country	:	US
Telephone Number	:	757-275-4198
Fax Number	:

Provider Business Practice Location Address
First Line	:	2260 SEASHORE SHOPPES
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1364
Country	:	US
Telephone Number	:	757-275-4198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2007
Last Update Date	:	07/09/2007

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