Healthcare Provider Details

I. General information

NPI: 1760661920
Provider Name (Legal Business Name): JOSEPH PHILLIP SMITH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 BOLINAS RD STE 2
FAIRFAX CA
94930
US

IV. Provider business mailing address

85 BOLINAS RD STE 2
FAIRFAX CA
94930-1626
US

V. Phone/Fax

Practice location:
  • Phone: 415-459-4411
  • Fax: 415-226-0450
Mailing address:
  • Phone: 415-459-4411
  • Fax: 415-226-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number29581
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number761
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: