MEDICARE: SMITH CHIROPRACTIC & WELLNESS CENTER LLC

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	DC011049	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942723051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITH CHIROPRACTIC & WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	3443 PENN AVE
Second Line	:
City	:	SINKING SPRING
State	:	PA
Zip	:	19608-1181
Country	:	US
Telephone Number	:	610-678-8600
Fax Number	:	610-678-4747

Provider Business Practice Location Address
First Line	:	3443 PENN AVE
Second Line	:
City	:	SINKING SPRING
State	:	PA
Zip	:	19608-1181
Country	:	US
Telephone Number	:	610-678-8600
Fax Number	:	610-678-4747

Authorized Official
Title or Position	:	OWNER
Name	:	TRISTAN ADAM SMITH
Credential	:	DC
Telephone Number	:	610-763-5251

Provider Enumeration Date	:	07/20/2017
Last Update Date	:	02/26/2021

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