Provider Demographics
NPI:1235590530
Name:SMITH CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:SMITH CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-541-0859
Mailing Address - Street 1:314 S 14TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-1762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:314 S 14TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1762
Practice Address - Country:US
Practice Address - Phone:712-541-0859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty