Provider Demographics
NPI:1558722371
Name:SMITH, WHITNEY (DC)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MI
Mailing Address - Zip Code:49237
Mailing Address - Country:US
Mailing Address - Phone:517-524-2225
Mailing Address - Fax:517-524-2226
Practice Address - Street 1:119 W JACKSON
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MI
Practice Address - Zip Code:49237
Practice Address - Country:US
Practice Address - Phone:517-524-2225
Practice Address - Fax:517-524-2226
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1558722371Medicaid