Healthcare Provider Details

I. General information

NPI: 1942593397
Provider Name (Legal Business Name): SMITH CHIROPRACTIC NORTHWEST, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4347 ROOSEVELT WAY NE
SEATTLE WA
98105-4717
US

IV. Provider business mailing address

4347 ROOSEVELT WAY NE
SEATTLE WA
98105-4717
US

V. Phone/Fax

Practice location:
  • Phone: 206-633-5556
  • Fax: 206-633-5559
Mailing address:
  • Phone: 206-633-5556
  • Fax: 206-633-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034880
License Number StateWA

VIII. Authorized Official

Name: DR. RYAN THOMAS SMITH
Title or Position: MANAGING MEMBER
Credential: DC
Phone: 206-633-5556