Provider Demographics
NPI:1386837722
Name:SMITH CHIROPRACTIC PAIN CENTER PC
Entity Type:Organization
Organization Name:SMITH CHIROPRACTIC PAIN CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:PRESCOTT
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-380-3860
Mailing Address - Street 1:2609 CANTRELL RD
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-4002
Mailing Address - Country:US
Mailing Address - Phone:816-380-3860
Mailing Address - Fax:816-380-3862
Practice Address - Street 1:2609 CANTRELL RD
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-4002
Practice Address - Country:US
Practice Address - Phone:816-380-3860
Practice Address - Fax:816-380-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002019357261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386837722OtherMEDICARE GROUP NPI NUMBER
31751019OtherBLUE CROSS BLUE SHIELD
31744016OtherBLUE CROSS BLUE SHIELD
MOM690000AMedicare PIN
31744016OtherBLUE CROSS BLUE SHIELD