Provider Demographics
NPI:1144340142
Name:SMITH, ELLIOTT ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:ANDREW
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 1:1805 S BELLAIRE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4305
Mailing Address - Country:US
Mailing Address - Phone:303-504-3600
Mailing Address - Fax:303-504-3605
Practice Address - Street 1:1805 S BELLAIRE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4305
Practice Address - Country:US
Practice Address - Phone:303-504-3600
Practice Address - Fax:303-504-3605
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU96926Medicare UPIN
CO511758Medicare ID - Type Unspecified