Provider Demographics
NPI:1134175417
Name:SMITH, AIMEE LYNNE (DC)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:LYNNE
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 1:322 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:ND
Mailing Address - Zip Code:58045-4905
Mailing Address - Country:US
Mailing Address - Phone:701-636-4606
Mailing Address - Fax:
Practice Address - Street 1:322 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:ND
Practice Address - Zip Code:58045-4905
Practice Address - Country:US
Practice Address - Phone:701-636-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND677111N00000X
MN3895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND611888OtherACN PROVIDER #
ND28G93SMOtherMNBCBS IND ID
NDSMI21948OtherNDBCBS IND ID
NDN71141Medicare PIN
NDSMI21948OtherNDBCBS IND ID
ND28G93SMOtherMNBCBS IND ID
ND611888OtherACN PROVIDER #
NDU78948Medicare UPIN