Provider Demographics
NPI:1558023150
Name:SMITH, EVLYN KATHRYN (DC)
Entity Type:Individual
Prefix:DR
First Name:EVLYN
Middle Name:KATHRYN
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:EVLYN
Other - Middle Name:KATHRYN
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5085 E 151ST ST S STE B
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-4016
Mailing Address - Country:US
Mailing Address - Phone:918-366-7100
Mailing Address - Fax:
Practice Address - Street 1:5085 E 151ST ST S STE B
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-4016
Practice Address - Country:US
Practice Address - Phone:918-366-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor