Provider Demographics
NPI:1114023629
Name:SMITH, DAN F (DC)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:F
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 1:607 N BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1607
Mailing Address - Country:US
Mailing Address - Phone:316-788-3744
Mailing Address - Fax:316-788-3745
Practice Address - Street 1:607 N BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-1607
Practice Address - Country:US
Practice Address - Phone:316-788-3744
Practice Address - Fax:316-788-3745
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060818OtherBC/BS
KS69043Medicare UPIN
KS059956Medicare ID - Type Unspecified