Provider Demographics
NPI:1407372535
Name:SMITH, LOGAN (DC)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
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 1:6837 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1635
Mailing Address - Country:US
Mailing Address - Phone:702-570-9051
Mailing Address - Fax:
Practice Address - Street 1:241 N BUFFALO DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0307
Practice Address - Country:US
Practice Address - Phone:702-852-1390
Practice Address - Fax:702-577-3334
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor