Provider Demographics
NPI:1891904611
Name:SMITH, JEFFREY LUTHER (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LUTHER
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 1:903 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4252
Mailing Address - Country:US
Mailing Address - Phone:352-336-2740
Mailing Address - Fax:352-336-2720
Practice Address - Street 1:903 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4252
Practice Address - Country:US
Practice Address - Phone:352-336-2740
Practice Address - Fax:352-336-2720
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55592OtherBCBS PROVIDER NUMBER