Healthcare Provider Details

I. General information

NPI: 1255464962
Provider Name (Legal Business Name): PAULINE MARIE SMITSON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12062 VALLEY VIEW ST SUITE 133
GARDEN GROVE CA
92845-1737
US

IV. Provider business mailing address

12062 VALLEY VIEW ST SUITE 133
GARDEN GROVE CA
92845-1737
US

V. Phone/Fax

Practice location:
  • Phone: 714-892-0888
  • Fax: 714-892-9171
Mailing address:
  • Phone: 714-892-0888
  • Fax: 714-892-9171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC22604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: