Provider Demographics
NPI:1538465414
Name:SMITH, JENNIFER D (DC, MSACN)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC, MSACN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 GENERAL JOSEPH WHEELER ST
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-2215
Mailing Address - Country:US
Mailing Address - Phone:585-278-7778
Mailing Address - Fax:
Practice Address - Street 1:20124 W CATAWBA AVE STE B
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4078
Practice Address - Country:US
Practice Address - Phone:585-278-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor