Provider Demographics
NPI:1477825297
Name:SMITH, BRENT THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:THOMAS
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 1:714 SEARLES RD
Mailing Address - Street 2:
Mailing Address - City:MARGARETVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12455-3033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 EAGLEVIEW LN
Practice Address - Street 2:
Practice Address - City:SCHWENKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19473
Practice Address - Country:US
Practice Address - Phone:845-594-4873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3363111N00000X
NY012097-1111N00000X
NJ38MC00695900111N00000X
PADC011274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor