=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649964701
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. SMIT'S LA CHIROPRACTIC AND NATURAL HEALTH CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2023
-----------------------------------------------------
Last Update Date | 06/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 761 E GREEN ST STE 4
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-2124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-345-5292
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1306 EL VAGO ST
-----------------------------------------------------
City | LA CANADA FLINTRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91011-1743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-377-4767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | DR. LINH LE SMIT
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 323-377-4767
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------