Provider Demographics
NPI:1619242450
Name:SMITH, LINDSEY A (DC)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:A
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 1:6385 STATE ROUTE 96
Mailing Address - Street 2:SUITE 210 PHOENIX MILLS PLAZA
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1411
Mailing Address - Country:US
Mailing Address - Phone:315-730-8646
Mailing Address - Fax:
Practice Address - Street 1:6385 STATE ROUTE 96
Practice Address - Street 2:SUITE 210
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1411
Practice Address - Country:US
Practice Address - Phone:315-730-8646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor