Provider Demographics
NPI:1063954899
Name:SMITH, KATRINA (DC)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 OLEANDER BLVD
Mailing Address - Street 2:8-201
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-5334
Mailing Address - Country:US
Mailing Address - Phone:772-240-8009
Mailing Address - Fax:
Practice Address - Street 1:2050 OLEANDER BLVD
Practice Address - Street 2:8-201
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-5334
Practice Address - Country:US
Practice Address - Phone:772-240-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor