Provider Demographics
NPI:1265571301
Name:SMITH, JAMES ALAN
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2739 E GRANDRIVER SUITE A
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-4513
Mailing Address - Country:US
Mailing Address - Phone:517-548-2560
Mailing Address - Fax:517-548-0771
Practice Address - Street 1:2739 E GRANDRIVER SUITE A
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-4513
Practice Address - Country:US
Practice Address - Phone:517-548-2560
Practice Address - Fax:517-548-0771
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1114186640OtherGROUP NPI
MI2910079Medicaid
MI950D752670OtherBCBS MICH
MI950D752670OtherBCBS MICH
MI2910079Medicaid