Provider Demographics
NPI:1699077255
Name:SMITH, HEIDI LOUISE (DC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LOUISE
Last Name:SMITH
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 1:510 N PROSPECT AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3032
Mailing Address - Country:US
Mailing Address - Phone:310-376-5433
Mailing Address - Fax:
Practice Address - Street 1:510 N PROSPECT AVE STE 207
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3032
Practice Address - Country:US
Practice Address - Phone:310-376-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31823111N00000X
CA17860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor