Provider Demographics
NPI:1326125584
Name:SMITH, DAVID JAMES (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
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 1:1740 WEIR DRIVE, SUITE 24
Mailing Address - Street 2:VALLEY CREEK MALL ANNEX
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2282
Mailing Address - Country:US
Mailing Address - Phone:651-232-6830
Mailing Address - Fax:651-702-2636
Practice Address - Street 1:1740 WEIR DRIVE, SUITE 24
Practice Address - Street 2:VALLEY CREEK MALL ANNEX
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2282
Practice Address - Country:US
Practice Address - Phone:651-232-6830
Practice Address - Fax:651-702-2636
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN494228100Medicaid
MN494228100Medicaid