Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 038012763 | IL |
N | 175F00000X | Naturopath | NT60832386 | WA |
NPI | 1396137816 |
---|---|
Provider Name | Dr. Stephen Justin Smitherman |
First Address | Lombard, IL 60148-4539 |
Second Address | Chicago, IL 60612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2015 |
Last Update Date | 23/07/2018 |