MEDICARE: DR. GREGORY LEE SMITH R.PH,DC

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	23375	CA
2	183500000X	Pharmacist	35063	CA

General Provider Information

NPI Number	:	1538176599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY LEE SMITH R.PH,DC

Provider Business Mailing Address
First Line	:	PO BOX 967
Second Line	:
City	:	KINGS BEACH
State	:	CA
Zip	:	96143-0967
Country	:	US
Telephone Number	:	530-546-8252
Fax Number	:

Provider Business Practice Location Address
First Line	:	8611 N LAKE BOULEVARD
Second Line	:	SUITE 200
City	:	KINGS BEACH
State	:	CA
Zip	:	96143-0967
Country	:	US
Telephone Number	:	530-546-8252
Fax Number	:

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	06/27/2014

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