Provider Demographics
NPI:1366625899
Name:SMITH, KEVIN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
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 1:1832 SCOTT RD
Mailing Address - Street 2:STE B1
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-9475
Mailing Address - Country:US
Mailing Address - Phone:208-874-3979
Mailing Address - Fax:
Practice Address - Street 1:1832 SCOTT RD
Practice Address - Street 2:STE B1
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249-9475
Practice Address - Country:US
Practice Address - Phone:208-874-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60040139111N00000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Yes111N00000XChiropractic ProvidersChiropractor