Provider Demographics
NPI:1205075835
Name:SMITH, KATHRYN MARGARET (DC)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:MARGARET
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 1:47 MCCLAY TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7580
Mailing Address - Country:US
Mailing Address - Phone:773-860-5187
Mailing Address - Fax:
Practice Address - Street 1:12324 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6443
Practice Address - Country:US
Practice Address - Phone:314-439-0777
Practice Address - Fax:314-439-0166
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor