Provider Demographics
NPI:1073787206
Name:SMITH, CHRISTOPHER DEWAINE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DEWAINE
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 1:100 RIVER WALK DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5243
Mailing Address - Country:US
Mailing Address - Phone:843-697-8631
Mailing Address - Fax:
Practice Address - Street 1:300 VIRGINIA RD STE D
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-9553
Practice Address - Country:US
Practice Address - Phone:843-697-8631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3848111N00000X
SC2008-072716111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician