Provider Demographics
NPI:1225130719
Name:SMITH, DARIAN LANCE (DC)
Entity Type:Individual
Prefix:DR
First Name:DARIAN
Middle Name:LANCE
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:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27285-0707
Mailing Address - Country:US
Mailing Address - Phone:336-996-2462
Mailing Address - Fax:336-996-9878
Practice Address - Street 1:127 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2815
Practice Address - Country:US
Practice Address - Phone:336-996-2462
Practice Address - Fax:336-996-9878
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890879BMedicaid
NC890879BMedicaid
NC2448242Medicare ID - Type Unspecified