Provider Demographics
NPI:1093297426
Name:SMITH, DELIA (DC, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E 68TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-2464
Mailing Address - Country:US
Mailing Address - Phone:816-914-8157
Mailing Address - Fax:
Practice Address - Street 1:1099 MILWAUKEE ST STE 240
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-7360
Practice Address - Country:US
Practice Address - Phone:314-822-1502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-01
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7117111N00000X
MO20200094732255A2300X
MN36922255A2300X
MO2023046993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer