Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 15394 | CA |
NPI | 1003999541 |
---|---|
Provider Name | Dr. Stephen Carroll Smith |
First Address | La Mirada, CA 90638-1600 |
Second Address | La Mirada, CA 90638-1600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 08/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U16899 | (02) | CA |