Provider Demographics
NPI:1124411533
Name:SMITH, ALICIA (LAC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:101 S FRONT ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4641
Mailing Address - Country:US
Mailing Address - Phone:906-236-0032
Mailing Address - Fax:248-461-1220
Practice Address - Street 1:101 S FRONT ST
Practice Address - Street 2:SUITE 309
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4641
Practice Address - Country:US
Practice Address - Phone:906-236-0032
Practice Address - Fax:248-461-1220
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5401000124171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist