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General NPI Number Information
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NPI Number | 1942593397
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Entity Type | Organization
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Legal Business Name | SMITH CHIROPRACTIC NORTHWEST, PLLC
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 4347 ROOSEVELT WAY NE
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City | SEATTLE
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State | WA
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Zip | 98105-4717
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Country | US
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Telephone | 206-633-5556
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Fax | 206-633-5559
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Provider Business Mailing Address
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Address Line | 4347 ROOSEVELT WAY NE
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City | SEATTLE
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State | WA
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Zip | 98105-4717
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Country | US
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Telephone | 206-633-5556
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Fax | 206-633-5559
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. RYAN THOMAS SMITH
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Credential | DC
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Telephone | 206-633-5556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH00034880
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License Number State | WA
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