Provider Demographics
NPI:1821180266
Name:SMITH, STEPHAN JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:JOHN
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 1:11319 SOUTH SAGINAW STREET
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1268
Mailing Address - Country:US
Mailing Address - Phone:810-694-2200
Mailing Address - Fax:810-694-6750
Practice Address - Street 1:11319 SOUTH SAGINAW STREET
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1268
Practice Address - Country:US
Practice Address - Phone:810-694-2200
Practice Address - Fax:810-694-6750
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00009050OtherMEDICARE RAILROAD CARRIER
MI01006003OtherHEALTH PLUS
1006672OtherMCLAREN HEALTH ADVA
P00009050OtherMEDICARE RAILROAD CARRIER