Provider Demographics
NPI:1316072911
Name:SMURRO, NICHOLAS WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:WILLIAM
Last Name:SMURRO
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 1:1525 S WILTON RD
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-1032
Mailing Address - Country:US
Mailing Address - Phone:253-565-6017
Mailing Address - Fax:
Practice Address - Street 1:9873 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2895
Practice Address - Country:US
Practice Address - Phone:253-588-1707
Practice Address - Fax:253-984-6731
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1992111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation