Provider Demographics
NPI:1912399171
Name:BRIAN J SMITH, DC
Entity Type:Organization
Organization Name:BRIAN J SMITH, DC
Other - Org Name:CHIROPRACTICMASSAGEMEDFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JARED
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-897-4055
Mailing Address - Street 1:329 S IVY ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3174
Mailing Address - Country:US
Mailing Address - Phone:541-897-4055
Mailing Address - Fax:
Practice Address - Street 1:329 S IVY ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3174
Practice Address - Country:US
Practice Address - Phone:541-897-4055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIAN J SMITH, DC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500667962Medicaid
ORR174112Medicare PIN