Provider Demographics
NPI:1770712119
Name:SMITH CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:SMITH CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-433-9000
Mailing Address - Street 1:522 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1256
Mailing Address - Country:US
Mailing Address - Phone:734-433-9000
Mailing Address - Fax:734-433-9009
Practice Address - Street 1:522 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1256
Practice Address - Country:US
Practice Address - Phone:734-433-9000
Practice Address - Fax:734-433-9009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RONALD G SMITH DC PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1712Medicare PIN