Provider Demographics
NPI:1134632789
Name:SMITH, KEILAND C (DC)
Entity type:Individual
Prefix:
First Name:KEILAND
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SE MELODY LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4804
Mailing Address - Country:US
Mailing Address - Phone:816-219-1977
Mailing Address - Fax:816-434-0898
Practice Address - Street 1:7777 FOREST LN STE B115
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6873
Practice Address - Country:US
Practice Address - Phone:972-566-3355
Practice Address - Fax:972-566-2040
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13634OtherCHIROPRACTIC LICENSE