Provider Demographics
NPI:1013910462
Name:SMITH, SADAT MALIK KWABENA (DC, MS, DIBCN, DIBE)
Entity Type:Individual
Prefix:DR
First Name:SADAT
Middle Name:MALIK KWABENA
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC, MS, DIBCN, DIBE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 S GOLDWYN AVE
Mailing Address - Street 2:UNIT 220
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-4324
Mailing Address - Country:US
Mailing Address - Phone:407-574-8542
Mailing Address - Fax:407-442-2071
Practice Address - Street 1:927 S GOLDWYN AVE
Practice Address - Street 2:UNIT 220
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-4324
Practice Address - Country:US
Practice Address - Phone:407-574-8542
Practice Address - Fax:407-442-2071
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381446700Medicaid
FLK3060Medicare PIN
FL381446700Medicaid
FLU87270Medicare UPIN