Provider Demographics
NPI:1437384468
Name:SMITH, BRENT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
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 1:5501 W HIGHWAY 290
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8803
Mailing Address - Country:US
Mailing Address - Phone:512-892-0544
Mailing Address - Fax:
Practice Address - Street 1:5501 W HIGHWAY 290
Practice Address - Street 2:SUITE B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8803
Practice Address - Country:US
Practice Address - Phone:512-892-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor