Provider Demographics
NPI:1609046424
Name:SMITH, CHARLOTTE ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:ANNE
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 1:316 W BELT LINE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2049
Mailing Address - Country:US
Mailing Address - Phone:972-291-8383
Mailing Address - Fax:972-291-8384
Practice Address - Street 1:316 W BELT LINE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2049
Practice Address - Country:US
Practice Address - Phone:972-291-8383
Practice Address - Fax:972-291-8384
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603541Medicare PIN