MEDICARE: DR. DEENA FAWN 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	111NN1001X	Nutrition Chiropractor	1987	SC

General Provider Information

NPI Number	:	1487880191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEENA FAWN SMITH D.C.

Provider Business Mailing Address
First Line	:	83 B CENTER ST.
Second Line	:	P O BOX 445
City	:	FOLLY BEACH
State	:	SC
Zip	:	29439
Country	:	US
Telephone Number	:	843-588-1230
Fax Number	:

Provider Business Practice Location Address
First Line	:	83 CENTER ST
Second Line	:
City	:	FOLLY BEACH
State	:	SC
Zip	:	29439
Country	:	US
Telephone Number	:	843-588-1230
Fax Number	:

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

Provider Enumeration Date	:	06/09/2009
Last Update Date	:	06/09/2009

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