Provider Demographics
NPI:1043230774
Name:SMITH, DESMOND JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:DESMOND
Middle Name:JOSEPH
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 1:1526 SE 47TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9613
Mailing Address - Country:US
Mailing Address - Phone:239-549-3266
Mailing Address - Fax:239-549-0727
Practice Address - Street 1:1526 SE 47TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9613
Practice Address - Country:US
Practice Address - Phone:239-549-3266
Practice Address - Fax:239-549-0727
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55784Medicare UPIN
FL88325Medicare ID - Type UnspecifiedMEDICARE ID NUMBER