Provider Demographics
NPI:1457732232
Name:SMITH, MICHAEL TODD (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TODD
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 1:800 W AIRPORT FWY
Mailing Address - Street 2:SUITE 959
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6312
Mailing Address - Country:US
Mailing Address - Phone:972-445-4134
Mailing Address - Fax:972-445-4134
Practice Address - Street 1:800 W AIRPORT FWY
Practice Address - Street 2:SUITE 959
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6312
Practice Address - Country:US
Practice Address - Phone:972-445-4134
Practice Address - Fax:972-445-4134
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor