Provider Demographics
NPI:1003003047
Name:SMITH CHIROPRACTIC CENTER P.C.
Entity Type:Organization
Organization Name:SMITH CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-965-3121
Mailing Address - Street 1:607 N SPARTA ST
Mailing Address - Street 2:P.O. BOX 51
Mailing Address - City:STEELEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62288-1536
Mailing Address - Country:US
Mailing Address - Phone:618-965-3121
Mailing Address - Fax:618-965-9163
Practice Address - Street 1:607 N SPARTA ST
Practice Address - Street 2:
Practice Address - City:STEELEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62288-1536
Practice Address - Country:US
Practice Address - Phone:618-965-3121
Practice Address - Fax:618-965-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL079-82012OtherBC/BS
IL129105OtherHEALTH LINK
IL209351Medicare UPIN