Basic Information
| Provider Information | |||||||||
| NPI: | 1780164251 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1160 N CONWELL AVE APT 309 | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917221303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234347844 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6221 WILSHIRE BLVD STE 518 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900485223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235490070 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2018 | ||||||||
| LastUpdateDate: | 08/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 34161 | CA | Y | Chiropractic Providers | Chiropractor |
No ID Information.