Provider Demographics
NPI:1811509466
Name:SMITH, MICHAEL BROWNING (DACM, LAC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BROWNING
Last Name:SMITH
Suffix:
Gender:M
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 REGENCY RD STE 3
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2334
Mailing Address - Country:US
Mailing Address - Phone:859-619-8364
Mailing Address - Fax:
Practice Address - Street 1:2039 REGENCY RD STE 3
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2334
Practice Address - Country:US
Practice Address - Phone:859-619-8364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAC136171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist