Provider Demographics
NPI:1326010687
Name:SMITH, MARK JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
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 1:3613 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2949
Mailing Address - Country:US
Mailing Address - Phone:502-895-3831
Mailing Address - Fax:502-895-9571
Practice Address - Street 1:3613 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2949
Practice Address - Country:US
Practice Address - Phone:502-895-3831
Practice Address - Fax:502-895-9571
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYV02528Medicare UPIN
KY6105201Medicare ID - Type Unspecified