MEDICARE: HEIDI SMITH CHIROPRACTIC INC.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1699077255	OTHER		NPI ENUMERATOR

General Provider Information

NPI Number	:	1578120002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEIDI SMITH CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	510 N PROSPECT AVE STE 207
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3032
Country	:	US
Telephone Number	:	310-376-5433
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 N PROSPECT AVE STE 207
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3032
Country	:	US
Telephone Number	:	310-376-5433
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HEIDI SMITH
Credential	:	D.C.
Telephone Number	:	310-850-9566

Provider Enumeration Date	:	05/20/2019
Last Update Date	:	12/31/2019

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Directions to “HEIDI SMITH CHIROPRACTIC INC. ” Practice Location

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