MEDICARE: MR. WAYNE CHRISTOPHER SMITH R.N.

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	163W00000X	Registered Nurse	534727	CA
2	111N00000X	Chiropractor	DC15629	CA

General Provider Information

NPI Number	:	1609055607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WAYNE CHRISTOPHER SMITH R.N.

Provider Business Mailing Address
First Line	:	229 20TH ST
Second Line	:	APT.C
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-3845
Country	:	US
Telephone Number	:	619-546-7927
Fax Number	:	619-546-7927

Provider Business Practice Location Address
First Line	:	229 20TH ST
Second Line	:	APT.C
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-3845
Country	:	US
Telephone Number	:	619-546-7927
Fax Number	:	619-546-7927

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

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	04/21/2015

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