Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH61124621 | WA |
N | 111NN1001X | Nutrition | CH61124621 | WA |
N | 111NR0200X | Radiology | CH61124621 | WA |
N | 213ER0200X | Radiology | CH61124621 | WA |
N | 111NR0400X | Rehabilitation Chiropractor | CH61124621 | WA |
N | 111NS0005X | Chiropractic Sports Physician | CH61124621 | WA |
NPI | 1750979274 |
---|---|
Provider Name | Dr. Donovan Smolich |
First Address | Tukwila, WA 98188-2549 |
Second Address | Tukwila, WA 98188-2549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2021 |
Last Update Date | 10/01/2021 |