Provider Demographics
NPI:1922305580
Name:SMITH CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:SMITH CHIROPRACTIC, PC
Other - Org Name:TRI-CITIES PAIN MANAGEMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-327-5086
Mailing Address - Street 1:1707 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4309
Mailing Address - Country:US
Mailing Address - Phone:505-258-4561
Mailing Address - Fax:505-324-0139
Practice Address - Street 1:1707 E 20TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4309
Practice Address - Country:US
Practice Address - Phone:505-258-4561
Practice Address - Fax:505-324-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain