Provider Demographics
NPI:1326367046
Name:DUANE H. SMITH DC PC
Entity Type:Organization
Organization Name:DUANE H. SMITH DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-331-4923
Mailing Address - Street 1:1520 N UNION BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2840
Mailing Address - Country:US
Mailing Address - Phone:719-632-1333
Mailing Address - Fax:719-632-1333
Practice Address - Street 1:1520 N UNION BLVD STE 101
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2840
Practice Address - Country:US
Practice Address - Phone:719-632-1333
Practice Address - Fax:719-632-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA102454Medicare PIN