Healthcare Provider Details

I. General information

NPI: 1477021327
Provider Name (Legal Business Name): LETITIA C SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 EDGE AVE
VALPARAISO FL
32580-1090
US

IV. Provider business mailing address

428 EDGE AVE
VALPARAISO FL
32580-1090
US

V. Phone/Fax

Practice location:
  • Phone: 850-695-9332
  • Fax:
Mailing address:
  • Phone: 850-695-9332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH12643
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: