Provider Demographics
NPI:1598876815
Name:JEFFERY T. SMITH CHIROPRACTIC, P.S.C.
Entity Type:Organization
Organization Name:JEFFERY T. SMITH CHIROPRACTIC, P.S.C.
Other - Org Name:SMITH CHIROPRACTIC, P.S.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-340-0340
Mailing Address - Street 1:1104 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-1903
Mailing Address - Country:US
Mailing Address - Phone:606-340-0340
Mailing Address - Fax:606-340-0211
Practice Address - Street 1:1104 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-1903
Practice Address - Country:US
Practice Address - Phone:606-340-0340
Practice Address - Fax:606-340-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7140Medicare PIN