Provider Demographics
NPI:1578989182
Name:SMITH, KEVIN AMMON (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:AMMON
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 N NAVARRO ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2417
Mailing Address - Country:US
Mailing Address - Phone:361-570-7354
Mailing Address - Fax:361-570-7356
Practice Address - Street 1:3708 N NAVARRO ST
Practice Address - Street 2:SUITE C
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2417
Practice Address - Country:US
Practice Address - Phone:361-570-7354
Practice Address - Fax:361-570-7356
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EG119OtherBCBS