MEDICARE: DR. ANGELA M 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	DC 29575	CA
2	111NN1001X	Nutrition Chiropractor	DC 29575	CA

General Provider Information

NPI Number	:	1659698868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA M SMITH DC

Provider Business Mailing Address
First Line	:	110 N RIOS AVE
Second Line	:
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-1238
Country	:	US
Telephone Number	:	858-794-9956
Fax Number	:	858-923-2093

Provider Business Practice Location Address
First Line	:	110 N RIOS AVE
Second Line	:
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-1238
Country	:	US
Telephone Number	:	858-794-9956
Fax Number	:	858-923-2093

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

Provider Enumeration Date	:	04/27/2010
Last Update Date	:	04/27/2010

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