MEDICARE: KEITH SMITH CHIROPRACTIC PROFESSIONAL CORPORATION

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	COR2622	CA

General Provider Information

NPI Number	:	1841313822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEITH SMITH CHIROPRACTIC PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	13136 LINCOLN WAY
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95603-4114
Country	:	US
Telephone Number	:	530-885-8205
Fax Number	:

Provider Business Practice Location Address
First Line	:	13136 LINCOLN WAY
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95603-4114
Country	:	US
Telephone Number	:	530-885-8205
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEITH T. SMITH
Credential	:	DC
Telephone Number	:	530-885-8205

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	05/03/2022

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