Provider Demographics
NPI:1871673368
Name:SMITH, STEPHEN (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
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 1:8806 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:IRA
Mailing Address - State:MI
Mailing Address - Zip Code:48023-2473
Mailing Address - Country:US
Mailing Address - Phone:586-725-7000
Mailing Address - Fax:586-725-7003
Practice Address - Street 1:8806 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:IRA
Practice Address - State:MI
Practice Address - Zip Code:48023-2473
Practice Address - Country:US
Practice Address - Phone:586-725-7000
Practice Address - Fax:586-725-7003
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISS007675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4450601Medicaid
MI4450601Medicaid
MIU93144Medicare UPIN