Provider Demographics
NPI:1336201870
Name:SMITH, JON ALAN (D C)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:ALAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-2827
Mailing Address - Country:US
Mailing Address - Phone:256-878-7413
Mailing Address - Fax:256-891-2301
Practice Address - Street 1:200 EAST SAND MOUNTAIN DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950
Practice Address - Country:US
Practice Address - Phone:256-891-7040
Practice Address - Fax:256-891-2301
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor