Provider Demographics
NPI:1720127806
Name:SMITH, MICHAEL J (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
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 1:3210 HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-5022
Mailing Address - Country:US
Mailing Address - Phone:850-872-1951
Mailing Address - Fax:850-872-1952
Practice Address - Street 1:3210 HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5022
Practice Address - Country:US
Practice Address - Phone:850-872-1951
Practice Address - Fax:850-872-1952
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-5609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
22054ZOtherMEDICARE ID
FL22054OtherBCBS OF FL
4347605OtherAETNA
FL593739233OtherPROVIDER ID
4534607OtherCIGNA
FL593739233OtherPROVIDER ID