Provider Demographics
NPI:1093859241
Name:SMITH CHIROPRACTIC AND REHABILITATION
Entity Type:Organization
Organization Name:SMITH CHIROPRACTIC AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-251-9300
Mailing Address - Street 1:W177N9856 RIVERCREST DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-4647
Mailing Address - Country:US
Mailing Address - Phone:262-251-9300
Mailing Address - Fax:262-251-9303
Practice Address - Street 1:W177N9856 RIVERCREST DR
Practice Address - Street 2:SUITE 102
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-4647
Practice Address - Country:US
Practice Address - Phone:262-251-9300
Practice Address - Fax:262-251-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2664111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIDB5091OtherRAILROAD MEDICARE
WIP00110391OtherRAILROAD MEDICARE
WI200879351018OtherBLUE CROSS
WI200879351018OtherBLUE CROSS
WIDB5091OtherRAILROAD MEDICARE