Healthcare Provider Details

I. General information

NPI: 1174248256
Provider Name (Legal Business Name): JEFFREY SCOTT SMITH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 W GRAND BLVD STE 101
CORONA CA
92882-2174
US

IV. Provider business mailing address

370 W GRAND BLVD STE 101
CORONA CA
92882-2174
US

V. Phone/Fax

Practice location:
  • Phone: 951-702-5254
  • Fax:
Mailing address:
  • Phone: 619-962-7202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3632
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: