Provider Demographics
NPI:1235337296
Name:SMITH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SMITH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-390-5404
Mailing Address - Street 1:5698 S US HIGHWAY 85-87
Mailing Address - Street 2:STE 110
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1465
Mailing Address - Country:US
Mailing Address - Phone:719-390-5404
Mailing Address - Fax:719-390-8313
Practice Address - Street 1:5698 S US HIGHWAY 85-87
Practice Address - Street 2:STE 110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1465
Practice Address - Country:US
Practice Address - Phone:719-390-5404
Practice Address - Fax:719-390-8313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC811837Medicare PIN