Provider Demographics
NPI:1457312720
Name:SMITHERS, MICHAEL D (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:SMITHERS
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 1:6440 S WASATCH BOULEVARD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121
Mailing Address - Country:US
Mailing Address - Phone:801-942-5814
Mailing Address - Fax:801-942-5897
Practice Address - Street 1:6440 S WASATCH BOULEVARD
Practice Address - Street 2:SUITE 270
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121
Practice Address - Country:US
Practice Address - Phone:801-942-5814
Practice Address - Fax:801-942-5897
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174623-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT78098Medicare UPIN