Provider Demographics
NPI:1770757569
Name:SMITH, MATTHEW DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:13552 S 110 W
Mailing Address - Street 2:STE 204
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-2403
Mailing Address - Country:US
Mailing Address - Phone:801-302-0280
Mailing Address - Fax:801-303-5040
Practice Address - Street 1:13552 S 110 W
Practice Address - Street 2:STE 204
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-2403
Practice Address - Country:US
Practice Address - Phone:801-302-0280
Practice Address - Fax:801-303-5040
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5188785-1202111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU92486Medicare UPIN