Provider Demographics
NPI:1346386406
Name:SMITH, SCOTT K (DC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:K
Last Name:SMITH
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 1:4750 OCEANSIDE BLVD STE A17
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3052
Mailing Address - Country:US
Mailing Address - Phone:760-945-4652
Mailing Address - Fax:760-945-4653
Practice Address - Street 1:4750 OCEANSIDE BLVD STE A17
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3052
Practice Address - Country:US
Practice Address - Phone:760-945-4652
Practice Address - Fax:760-945-4653
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19611111N00000X
MT590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU24370Medicare UPIN