Provider Demographics
NPI:1275750952
Name:SMIDT, CAROLYN A (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:A
Last Name:SMIDT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W KENWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-2132
Mailing Address - Country:US
Mailing Address - Phone:502-363-4364
Mailing Address - Fax:502-363-4364
Practice Address - Street 1:202 W KENWOOD WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-2132
Practice Address - Country:US
Practice Address - Phone:502-363-4364
Practice Address - Fax:502-363-4364
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000112317OtherANTHEM PROVIDER NUMBER
KY0004306869OtherPROVIDER PIN NUMBER AETNA