Healthcare Provider Details

I. General information

NPI: 1013550409
Provider Name (Legal Business Name): IMPACT CHIROPRACTIC, SMITH CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 E PACIFIC COAST HWY STE 120
LONG BEACH CA
90803-4244
US

IV. Provider business mailing address

3723 LEES AVE
LONG BEACH CA
90808-2333
US

V. Phone/Fax

Practice location:
  • Phone: 562-414-5001
  • Fax: 562-414-5002
Mailing address:
  • Phone: 562-810-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN CRAIG SMITH
Title or Position: OWNER
Credential: DC
Phone: 562-810-4401