Healthcare Provider Details

I. General information

NPI: 1639438278
Provider Name (Legal Business Name): SARAH C SMIRNOVA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH C COUET D.C.

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 JACKSON RD STE F
ANN ARBOR MI
48103-9597
US

IV. Provider business mailing address

6360 JACKSON RD STE F
ANN ARBOR MI
48103-9597
US

V. Phone/Fax

Practice location:
  • Phone: 734-369-9990
  • Fax: 346-610-7847
Mailing address:
  • Phone: 734-369-9990
  • Fax: 734-661-0784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009951
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: