MEDICARE: SMITH CHIROPRACTIC CORPORATION

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	COR690	CA

General Provider Information

NPI Number	:	1710190723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITH CHIROPRACTIC CORPORATION

Provider Business Mailing Address
First Line	:	1001 B AVE
Second Line	:	STE 303
City	:	CORONADO
State	:	CA
Zip	:	92118-3421
Country	:	US
Telephone Number	:	619-435-4175
Fax Number	:	619-435-2995

Provider Business Practice Location Address
First Line	:	1001 B AVE
Second Line	:	STE 303
City	:	CORONADO
State	:	CA
Zip	:	92118-3421
Country	:	US
Telephone Number	:	619-435-4175
Fax Number	:	619-435-2995

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARILYN P SMITH
Credential	:	D.C.
Telephone Number	:	619-435-4175

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	08/22/2020

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Directions to “SMITH CHIROPRACTIC CORPORATION ” Practice Location

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