=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215088919
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERENCE SMITH DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4449 N 12TH STREET SUITE C3
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85014-4598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-274-8820
-----------------------------------------------------
Fax | 602-274-1075
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4449 N 12TH STREET SUITE C3
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85014-4598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-274-8820
-----------------------------------------------------
Fax | 602-274-1075
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4192
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------