Provider Demographics
NPI:1811927320
Name:SMITH, MICHELLE L (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 TOWN AND COUNTRY COMMONS
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8200
Mailing Address - Country:US
Mailing Address - Phone:636-207-2200
Mailing Address - Fax:636-207-2201
Practice Address - Street 1:1176 TOWN AND COUNTRY COMMONS
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-8200
Practice Address - Country:US
Practice Address - Phone:636-207-2200
Practice Address - Fax:636-207-2201
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001000396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000031903Medicare ID - Type Unspecified
MOU83237Medicare UPIN