Provider Demographics
NPI:1194486449
Name:SMOAK, JAMIE MARIE (DC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:SMOAK
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 1:10090 HIGHWAY 9 STE 5
Mailing Address - Street 2:
Mailing Address - City:BEN LOMOND
Mailing Address - State:CA
Mailing Address - Zip Code:95005-9251
Mailing Address - Country:US
Mailing Address - Phone:831-420-7980
Mailing Address - Fax:
Practice Address - Street 1:10090 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:BEN LOMOND
Practice Address - State:CA
Practice Address - Zip Code:95005-9241
Practice Address - Country:US
Practice Address - Phone:831-420-7980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty