MEDICARE: SMALLIE 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	DC11659	CA

General Provider Information

NPI Number	:	1972559466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMALLIE CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	2027 GRAND CANAL BLVD
Second Line	:	SUITE 21
City	:	STOCKTON
State	:	CA
Zip	:	95207-6650
Country	:	US
Telephone Number	:	209-957-9601
Fax Number	:	209-956-6808

Provider Business Practice Location Address
First Line	:	2027 GRAND CANAL BLVD
Second Line	:	SUITE 21
City	:	STOCKTON
State	:	CA
Zip	:	95207-6650
Country	:	US
Telephone Number	:	209-957-9601
Fax Number	:	209-956-6808

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. DON DAVID SMALLIE
Credential	:	DC
Telephone Number	:	209-957-9601

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	02/05/2013

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