Provider Demographics
NPI:1588286223
Name:STREET SMARTZ CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:STREET SMARTZ CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-519-5005
Mailing Address - Street 1:1643 N ALPINE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1464
Mailing Address - Country:US
Mailing Address - Phone:815-398-8023
Mailing Address - Fax:815-399-2430
Practice Address - Street 1:818 COOLIDGE PL
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3638
Practice Address - Country:US
Practice Address - Phone:815-398-8023
Practice Address - Fax:815-399-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-16
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty