Provider Demographics
NPI:1184837817
Name:SMITH CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:SMITH CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-788-3126
Mailing Address - Street 1:239 BRANCHVIEW DR NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-3416
Mailing Address - Country:US
Mailing Address - Phone:704-788-3126
Mailing Address - Fax:704-788-2516
Practice Address - Street 1:239 BRANCHVIEW DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-3416
Practice Address - Country:US
Practice Address - Phone:704-788-3126
Practice Address - Fax:704-788-2516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905934Medicaid
NCT64295Medicare UPIN
NC244221Medicare ID - Type Unspecified