Provider Demographics
NPI:1629371364
Name:SMYTH, MICHAEL CHRISTIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHRISTIAN
Last Name:SMYTH
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 1:706 BOTANY LOOP
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7166
Mailing Address - Country:US
Mailing Address - Phone:719-287-1554
Mailing Address - Fax:
Practice Address - Street 1:113 WACCAMAW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8902
Practice Address - Country:US
Practice Address - Phone:843-331-8262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor