Provider Demographics
NPI:1104028687
Name:SMITH, NORMAN ALAN (DC)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:ALAN
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:PO BOX 37
Mailing Address - Street 2:307 MAIN ST
Mailing Address - City:PINEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64856
Mailing Address - Country:US
Mailing Address - Phone:417-223-4103
Mailing Address - Fax:417-223-4102
Practice Address - Street 1:307 MAIN ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:MO
Practice Address - Zip Code:64856
Practice Address - Country:US
Practice Address - Phone:417-223-4103
Practice Address - Fax:417-223-4102
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2106860001Medicaid
MO2106860001Medicaid