Provider Demographics
NPI:1760433551
Name:SMITH, VERNON CURTIS (DC)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:CURTIS
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 1:1810 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4611
Mailing Address - Country:US
Mailing Address - Phone:918-836-6454
Mailing Address - Fax:918-836-6455
Practice Address - Street 1:3242 EAST ADMIRAL PLACE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74110-5536
Practice Address - Country:US
Practice Address - Phone:918-836-6454
Practice Address - Fax:918-836-6455
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
C22014Medicare UPIN