Provider Demographics
NPI:1902115579
Name:BRENT M. SMITH, D.C. A CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:BRENT M. SMITH, D.C. A CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:MYRON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-552-1172
Mailing Address - Street 1:4200 TRABUCO RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3600
Mailing Address - Country:US
Mailing Address - Phone:949-552-1172
Mailing Address - Fax:949-552-8172
Practice Address - Street 1:4200 TRABUCO RD
Practice Address - Street 2:SUITE 180
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3600
Practice Address - Country:US
Practice Address - Phone:949-552-1172
Practice Address - Fax:949-552-8172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty