Provider Demographics
NPI:1508893546
Name:SMILEY, JOHN DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:SMILEY
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:PO BOX 1181
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-1181
Mailing Address - Country:US
Mailing Address - Phone:918-422-6118
Mailing Address - Fax:918-422-6192
Practice Address - Street 1:768 STATELINE RD
Practice Address - Street 2:
Practice Address - City:COLCORD
Practice Address - State:OK
Practice Address - Zip Code:74338-1346
Practice Address - Country:US
Practice Address - Phone:918-422-6118
Practice Address - Fax:918-422-6192
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100832070AMedicaid
OK100832070AMedicaid