Provider Demographics
NPI:1740665876
Name:SMITH CHIROPRACTIC AND WELLNESS,LLC
Entity type:Organization
Organization Name:SMITH CHIROPRACTIC AND WELLNESS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:DOYLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-342-3333
Mailing Address - Street 1:2901 S GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3436
Mailing Address - Country:US
Mailing Address - Phone:806-342-3333
Mailing Address - Fax:806-350-7792
Practice Address - Street 1:2901 S GEORGIA ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3436
Practice Address - Country:US
Practice Address - Phone:806-342-3333
Practice Address - Fax:806-350-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169494501Medicaid
TX713992467OtherTEXAS PROVIDER ID
TX611188OtherMEDICARE