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General NPI Number Information
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NPI Number | 1194993790
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Entity Type | Organization
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Legal Business Name | SMITH CHIROPRACTIC OFFICE S.C.
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 22230 75TH ST
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City | SALEM
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State | WI
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Zip | 53168-9465
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Country | US
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Telephone | 262-843-3013
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Fax | 262-843-2427
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Provider Business Mailing Address
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Address Line | 22230 75TH ST
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City | SALEM
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State | WI
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Zip | 53168-9465
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Country | US
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Telephone | 262-843-3013
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Fax | 262-843-2427
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | MR. BRADLEY JAMES SMITH
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Credential | D.C.
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Telephone | 262-843-3013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1784-012
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License Number State | WI
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