=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447641857
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMITH CHIROPRACTIC AND SPORTS THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2015
-----------------------------------------------------
Last Update Date | 02/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2598 W MIDDLEFIELD RD
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94043-2732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-396-9136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 943 W WASHINGTON AVE
-----------------------------------------------------
City | SUNNYVALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94086-5903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-396-9136
-----------------------------------------------------
Fax | 650-396-4036
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MATTHEW SMITH
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 650-279-5078
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 33141
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------