Provider Demographics
NPI:1689779647
Name:JOHN A SMITH, DC, CCSP, PA
Entity Type:Organization
Organization Name:JOHN A SMITH, DC, CCSP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-878-8848
Mailing Address - Street 1:2926 CAPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3235
Mailing Address - Country:US
Mailing Address - Phone:919-878-8848
Mailing Address - Fax:919-878-8863
Practice Address - Street 1:2926 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3235
Practice Address - Country:US
Practice Address - Phone:919-878-8848
Practice Address - Fax:919-878-8863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1412111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty