Provider Demographics
NPI:1255396990
Name:SMITH, MARK A (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:1003 DEL PRADO BLVD S
Mailing Address - Street 2:STE 302
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3601
Mailing Address - Country:US
Mailing Address - Phone:239-772-3232
Mailing Address - Fax:239-458-3272
Practice Address - Street 1:1404 DEL PRADO BLVD S
Practice Address - Street 2:SUITE 110
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3774
Practice Address - Country:US
Practice Address - Phone:239-772-3232
Practice Address - Fax:239-458-3272
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2017-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLCH5040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380840800Medicaid
FL380840800Medicaid
FLT55016Medicare UPIN