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General NPI Number Information
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NPI Number | 1720107212
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Entity Type | Individual
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Provider Name | IAN B SMITH LMP
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6223 112TH ST E
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City | PUYALLUP
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State | WA
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Zip | 98373-4316
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Country | US
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Telephone | 253-286-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 11723 63RD AVE E
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City | PUYALLUP
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State | WA
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Zip | 98373-4333
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Country | US
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Telephone | 253-961-2819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MA00021875
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License Number State | WA
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