Provider Demographics
NPI:1194993790
Name:SMITH CHIROPRACTIC OFFICE S.C.
Entity type:Organization
Organization Name:SMITH CHIROPRACTIC OFFICE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-843-3013
Mailing Address - Street 1:22230 75TH ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-9465
Mailing Address - Country:US
Mailing Address - Phone:262-843-3013
Mailing Address - Fax:262-843-2427
Practice Address - Street 1:22230 75TH ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WI
Practice Address - Zip Code:53168-9465
Practice Address - Country:US
Practice Address - Phone:262-843-3013
Practice Address - Fax:262-843-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1784-012261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center