MEDICARE: LARISSA ROSE SMITH D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	36711	CA

General Provider Information

NPI Number	:	1417743451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARISSA ROSE SMITH D.C.

Provider Business Mailing Address
First Line	:	13136 LINCOLN WAY
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95603-4114
Country	:	US
Telephone Number	:	308-858-2055
Fax Number	:	530-885-0303

Provider Business Practice Location Address
First Line	:	13136 LINCOLN WAY
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95603-4114
Country	:	US
Telephone Number	:	308-858-2055
Fax Number	:	530-885-0303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2025
Last Update Date	:	04/16/2025

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