Provider Demographics
NPI:1174857205
Name:TABOR SMITH D.C. P.A.
Entity Type:Organization
Organization Name:TABOR SMITH D.C. P.A.
Other - Org Name:PURE LIFE FAMILY WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:TABOR
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-664-2250
Mailing Address - Street 1:19500 STATE HIGHWAY 249 STE 285
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3024
Mailing Address - Country:US
Mailing Address - Phone:281-664-2250
Mailing Address - Fax:281-664-2250
Practice Address - Street 1:19500 STATE HIGHWAY 249 STE 285
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3024
Practice Address - Country:US
Practice Address - Phone:281-664-2250
Practice Address - Fax:281-664-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1588851489Medicare PIN