Provider Demographics
NPI:1518938125
Name:SMITHSON, DOUGLAS JOEL (DC PHD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JOEL
Last Name:SMITHSON
Suffix:
Gender:M
Credentials:DC PHD
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 1342
Mailing Address - Street 2:
Mailing Address - City:SEELEY LAKE
Mailing Address - State:MT
Mailing Address - Zip Code:59868-1342
Mailing Address - Country:US
Mailing Address - Phone:406-677-5111
Mailing Address - Fax:
Practice Address - Street 1:3166 HWY 83 NO
Practice Address - Street 2:
Practice Address - City:SEELEY LAKE
Practice Address - State:MT
Practice Address - Zip Code:59868-1195
Practice Address - Country:US
Practice Address - Phone:406-677-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT293111N00000X
MN1256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT41950OtherBCBS
MTT60145OtherHCFA NAT NC