Provider Demographics
NPI:1285797381
Name:SMASAL FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:SMASAL FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMASAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-774-6757
Mailing Address - Street 1:2900 N 117TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4106
Mailing Address - Country:US
Mailing Address - Phone:414-774-6757
Mailing Address - Fax:414-774-6734
Practice Address - Street 1:2900 N 117TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-4106
Practice Address - Country:US
Practice Address - Phone:414-774-6757
Practice Address - Fax:414-774-6734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4101-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU87022Medicare UPIN
WI000035827Medicare ID - Type Unspecified