Healthcare Provider Details

I. General information

NPI: 1588055248
Provider Name (Legal Business Name): STEPHEN W. SMITH CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8821 VALLEY VIEW ST
BUENA PARK CA
90620-3528
US

IV. Provider business mailing address

8821 VALLEY VIEW ST
BUENA PARK CA
90620-3528
US

V. Phone/Fax

Practice location:
  • Phone: 714-527-3332
  • Fax: 714-527-3313
Mailing address:
  • Phone: 714-527-3332
  • Fax: 714-527-3313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC19696
License Number StateCA

VIII. Authorized Official

Name: SEYED AZIZI
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 714-527-3332