Provider Demographics
NPI:1821131897
Name:SMITH, ANDREW H (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:H
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 1:12300 ALT. A1A
Mailing Address - Street 2:SUITE 119
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-625-1993
Mailing Address - Fax:
Practice Address - Street 1:12300 ALT.A1A
Practice Address - Street 2:SUITE 119
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-625-1993
Practice Address - Fax:561-625-6088
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV06531Medicare UPIN