Provider Demographics
NPI:1902936206
Name:SMITHSON, STUART LEE (DC)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:LEE
Last Name:SMITHSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 S. UNION ST.
Mailing Address - Street 2:SUITE C
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338
Mailing Address - Country:US
Mailing Address - Phone:509-783-7242
Mailing Address - Fax:509-783-7286
Practice Address - Street 1:2411 S. UNION ST.
Practice Address - Street 2:SUITE C
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338
Practice Address - Country:US
Practice Address - Phone:509-783-7242
Practice Address - Fax:509-783-7286
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB15638Medicare ID - Type Unspecified
WAT02427Medicare UPIN