Provider Demographics
NPI:1801835640
Name:SMITH, JASON LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9219 MIDDLEBROOK PIKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4756
Mailing Address - Country:US
Mailing Address - Phone:865-531-1800
Mailing Address - Fax:865-531-0721
Practice Address - Street 1:9219 MIDDLEBROOK PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-4756
Practice Address - Country:US
Practice Address - Phone:865-531-1800
Practice Address - Fax:865-531-0721
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU60948Medicare UPIN