Provider Demographics
NPI:1265514632
Name:SMITH, JONATHAN D (DC W/ PT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC W/ PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 E LOHMAN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8288
Mailing Address - Country:US
Mailing Address - Phone:575-521-0793
Mailing Address - Fax:575-532-1607
Practice Address - Street 1:225 E IDAHO AVE STE 30
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3242
Practice Address - Country:US
Practice Address - Phone:575-644-0238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1961111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician