Provider Demographics
NPI:1124181714
Name:SMITH, KANYON R (DC)
Entity Type:Individual
Prefix:MR
First Name:KANYON
Middle Name:R
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 1:6446 US HWY 93 SOUTH
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8237
Mailing Address - Country:US
Mailing Address - Phone:406-862-7655
Mailing Address - Fax:406-862-9750
Practice Address - Street 1:6446 US HWY 93 SOUTH
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-8237
Practice Address - Country:US
Practice Address - Phone:406-862-7655
Practice Address - Fax:406-862-9750
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0163710Medicaid
MT40393OtherBLUE CROSS BLUE SHIELD