Healthcare Provider Details

I. General information

NPI: 1740659895
Provider Name (Legal Business Name): S.M.A.R.T. SPINE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E HUNTINGTON DR
ARCADIA CA
91006-3212
US

IV. Provider business mailing address

131 E HUNTINGTON DR
ARCADIA CA
91006-3212
US

V. Phone/Fax

Practice location:
  • Phone: 626-445-0326
  • Fax: 626-445-5155
Mailing address:
  • Phone: 626-445-0326
  • Fax: 626-445-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DEVON ANDERSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 626-445-0326