Provider Demographics
NPI:1598878498
Name:SMITH, JENNIFER (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
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 1:2809 N BROADWAY ST
Mailing Address - Street 2:STE E
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-2684
Mailing Address - Country:US
Mailing Address - Phone:620-232-3600
Mailing Address - Fax:620-232-3616
Practice Address - Street 1:2809 N BROADWAY ST
Practice Address - Street 2:SUITE A
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-2626
Practice Address - Country:US
Practice Address - Phone:620-232-3600
Practice Address - Fax:620-232-3616
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04957111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1006Medicare UPIN
KS1598878498Medicare PIN