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General NPI Number Information
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NPI Number | 1093859241
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Entity Type | Organization
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Legal Business Name | SMITH CHIROPRACTIC AND REHABILITATION
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | W177N9856 RIVERCREST DR SUITE 102
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City | GERMANTOWN
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State | WI
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Zip | 53022-4647
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Country | US
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Telephone | 262-251-9300
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Fax | 262-251-9303
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Provider Business Mailing Address
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Address Line | W177N9856 RIVERCREST DR SUITE 102
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City | GERMANTOWN
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State | WI
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Zip | 53022-4647
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Country | US
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Telephone | 262-251-9300
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Fax | 262-251-9303
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS PAUL SMITH
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Credential | D.C.
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Telephone | 262-251-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 2664
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License Number State | WI
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