Healthcare Provider Details

I. General information

NPI: 1457361461
Provider Name (Legal Business Name): JOHN DAVID SMART L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 9TH AVE NE STE 300
SEATTLE WA
98115-8516
US

IV. Provider business mailing address

2606 NW 98TH ST
SEATTLE WA
98117-2523
US

V. Phone/Fax

Practice location:
  • Phone: 206-363-5555
  • Fax:
Mailing address:
  • Phone: 206-794-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00000780
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: