Provider Demographics
NPI:1548644131
Name:SMITH, TRISTAN ADAM (DC)
Entity type:Individual
Prefix:MR
First Name:TRISTAN
Middle Name:ADAM
Last Name:SMITH
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 1:3443 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-1181
Mailing Address - Country:US
Mailing Address - Phone:610-678-8600
Mailing Address - Fax:610-678-4747
Practice Address - Street 1:3443 PENN AVE
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-1181
Practice Address - Country:US
Practice Address - Phone:610-678-8600
Practice Address - Fax:610-678-4747
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor