Provider Demographics
NPI:1053322487
Name:SMITH, BENJAMIN DREW (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DREW
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 1:3717 VERDE DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-8189
Mailing Address - Country:US
Mailing Address - Phone:682-831-0598
Mailing Address - Fax:
Practice Address - Street 1:4851 S INTERSTATE 35 E
Practice Address - Street 2:SUITE 202
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-2348
Practice Address - Country:US
Practice Address - Phone:940-270-2222
Practice Address - Fax:940-269-2223
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P9670OtherBCBS PROVIDER
TX00150XOtherGROUP
TX8P9670OtherBCBS PROVIDER
TX00150XOtherGROUP