Provider Demographics
NPI:1760580294
Name:SMITH, DENNIS T (DC DACNB)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:CAVALIER
Mailing Address - State:ND
Mailing Address - Zip Code:58220
Mailing Address - Country:US
Mailing Address - Phone:701-265-8841
Mailing Address - Fax:
Practice Address - Street 1:206 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220
Practice Address - Country:US
Practice Address - Phone:701-265-3380
Practice Address - Fax:701-265-3371
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND24463Medicare ID - Type Unspecified
U94562Medicare UPIN