Provider Demographics
NPI:1104414630
Name:SMOLICH, CALVIN (DC)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:
Last Name:SMOLICH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 SOUTHCENTER BLVD STE 60
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2549
Mailing Address - Country:US
Mailing Address - Phone:206-349-8724
Mailing Address - Fax:
Practice Address - Street 1:6510 SOUTHCENTER BLVD STE 60
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2549
Practice Address - Country:US
Practice Address - Phone:206-349-8724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61124573111NN1001X, 111NR0200X, 111NS0005X, 111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NR0400XChiropractic ProvidersChiropractorRehabilitation