Provider Demographics
NPI:1629463278
Name:SMITH, DEREK (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:SMITH
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 1:20 EXECUTIVE DR
Mailing Address - Street 2:STE A
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2988
Mailing Address - Country:US
Mailing Address - Phone:317-993-3361
Mailing Address - Fax:317-993-3362
Practice Address - Street 1:20 EXECUTIVE DR
Practice Address - Street 2:STE A
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2988
Practice Address - Country:US
Practice Address - Phone:317-993-3361
Practice Address - Fax:317-993-3362
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor