Provider Demographics
NPI:1114988284
Name:SMEDSTAD, TERRY A (DC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:A
Last Name:SMEDSTAD
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 1:4801 WOODWAY DR
Mailing Address - Street 2:SUITE 175-E
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-1813
Mailing Address - Country:US
Mailing Address - Phone:713-622-2225
Mailing Address - Fax:713-622-1031
Practice Address - Street 1:4801 WOODWAY DR
Practice Address - Street 2:SUITE 175-E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-1813
Practice Address - Country:US
Practice Address - Phone:713-622-2225
Practice Address - Fax:713-622-1031
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G2970OtherBLUE CROSS BLUE SHEILD
TX601041Medicare PIN