Provider Demographics
NPI:1912047838
Name:SMITH, JAMES ELLIS (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ELLIS
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 1:2100 E OCEAN VIEW AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-6101
Mailing Address - Country:US
Mailing Address - Phone:757-431-2225
Mailing Address - Fax:757-431-9314
Practice Address - Street 1:397 LITTLE NECK RD STE 108 BLDG 3400
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5764
Practice Address - Country:US
Practice Address - Phone:757-431-2225
Practice Address - Fax:757-431-9314
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3229111N00000X
VA0104556551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor