Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 7502 | AZ |
NPI | 1003248154 |
---|---|
Provider Name | Dr. Chris William Smith |
First Address | New River, AZ 85087-7019 |
Second Address | Phoenix, AZ 85085-8862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2013 |
Last Update Date | 31/07/2013 |