Provider Demographics
NPI:1598767592
Name:SMITH, JAMES A (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 S BAXTER AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2210
Mailing Address - Country:US
Mailing Address - Phone:903-595-2664
Mailing Address - Fax:903-592-8461
Practice Address - Street 1:945 S BAXTER AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2210
Practice Address - Country:US
Practice Address - Phone:903-595-2664
Practice Address - Fax:903-592-8461
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001052201Medicaid
TX600808Medicare ID - Type Unspecified
T90059Medicare UPIN