Provider Demographics
NPI:1407833783
Name:SMITH, JAMES E (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
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 1:704 CEDAR POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28584-8012
Mailing Address - Country:US
Mailing Address - Phone:252-393-5090
Mailing Address - Fax:252-393-3567
Practice Address - Street 1:704 CEDAR POINT BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR POINT
Practice Address - State:NC
Practice Address - Zip Code:28584-8012
Practice Address - Country:US
Practice Address - Phone:252-393-5090
Practice Address - Fax:252-393-3567
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085P5OtherBLUE CROSS PROVIDER #
NC89085P5Medicaid
NCU69404Medicare UPIN
NC89085P5Medicaid