Provider Demographics
NPI:1477625564
Name:SMITH, ERIC ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ANDREW
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 1:1841 DOLOMITE WAY
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-3057
Mailing Address - Country:US
Mailing Address - Phone:303-663-1124
Mailing Address - Fax:
Practice Address - Street 1:9797 W COLFAX AVE STE 3UU
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-3924
Practice Address - Country:US
Practice Address - Phone:303-435-4382
Practice Address - Fax:303-232-7687
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO5023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC44633Medicare ID - Type Unspecified
COU84447Medicare UPIN