MEDICARE: DR. ROAUL DIETRICK SMITH 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	CH00034502	WA

General Provider Information

NPI Number	:	1588654354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROAUL DIETRICK SMITH DC

Provider Business Mailing Address
First Line	:	9015 13TH ST NE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258
Country	:	US
Telephone Number	:	425-397-6881
Fax Number	:

Provider Business Practice Location Address
First Line	:	1666 E. OLIVE WAY
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102
Country	:	US
Telephone Number	:	206-323-1666
Fax Number	:	206-323-6639

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. ROAUL DIETRICK SMITH DC” Practice Location

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