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General NPI Number Information
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NPI Number | 1992984546
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Entity Type | Organization
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Legal Business Name | SMITH CHIROPRACTIC
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 1700 S HIGHWAY 92 STE E1
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-5858
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Country | US
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Telephone | 520-459-5199
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Fax | 520-459-1303
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Provider Business Mailing Address
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Address Line | 1700 S HIGHWAY 92 SUITE E1
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-5856
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Country | US
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Telephone | 520-459-5199
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Fax | 520-459-1303
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Authorized Official
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Title or Position | OWNER/SOLE PROPRIETOR
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Name | KELLY R SMITH
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Credential | D.C.
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Telephone | 520-459-5199
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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 | 4487
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License Number State | AZ
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