Provider Demographics
NPI:1215045075
Name:SMITH, JEFFREY AVERY (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:AVERY
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 1:157 PEARL STREET
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8234
Mailing Address - Country:US
Mailing Address - Phone:508-875-4086
Mailing Address - Fax:508-620-1492
Practice Address - Street 1:157 PEARL ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8234
Practice Address - Country:US
Practice Address - Phone:508-875-4086
Practice Address - Fax:508-620-1492
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35456Medicare ID - Type Unspecified