Provider Demographics
NPI:1538323118
Name:SMITH AND SMITH CHIROPRACTIC GROUP INC.
Entity Type:Organization
Organization Name:SMITH AND SMITH CHIROPRACTIC GROUP INC.
Other - Org Name:ACTIVE FAMILY SPORTS AND CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-785-6771
Mailing Address - Street 1:36434 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1330
Mailing Address - Country:US
Mailing Address - Phone:727-785-6771
Mailing Address - Fax:727-781-0657
Practice Address - Street 1:36434 US HWY 19 N.
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3110
Practice Address - Country:US
Practice Address - Phone:727-785-6771
Practice Address - Fax:727-781-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2800187-00Medicaid
FL2800187-00Medicaid
FL53959Medicare PIN