Provider Demographics
NPI:1932675261
Name:SMITH, MELISSA DAWN VANDERPOOL (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:DAWN VANDERPOOL
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 W AVENUE F
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-2927
Mailing Address - Country:US
Mailing Address - Phone:214-817-8603
Mailing Address - Fax:
Practice Address - Street 1:218 W AVENUE F
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-2927
Practice Address - Country:US
Practice Address - Phone:214-817-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-13
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty