Provider Demographics
NPI:1740649284
Name:SMITH, GARRETT
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:GARRETT
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:527 N 291 HWY STE B
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1071
Mailing Address - Country:US
Mailing Address - Phone:816-407-9800
Mailing Address - Fax:816-407-9811
Practice Address - Street 1:527 N 291 HWY STE B
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1071
Practice Address - Country:US
Practice Address - Phone:816-806-8744
Practice Address - Fax:816-407-9811
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016004608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor