Provider Demographics
NPI:1801800271
Name:SMITH, CLIFFORD CORNELIUS II (DC)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:CORNELIUS
Last Name:SMITH
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:41472-0088
Mailing Address - Country:US
Mailing Address - Phone:606-743-3617
Mailing Address - Fax:606-743-9790
Practice Address - Street 1:389 GLENN AVE
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472-1119
Practice Address - Country:US
Practice Address - Phone:606-743-3617
Practice Address - Fax:606-743-9790
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor