Provider Demographics
NPI:1831268879
Name:CHRIS A SMITH DC CHIROPRACTIC PC
Entity type:Organization
Organization Name:CHRIS A SMITH DC CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-378-1515
Mailing Address - Street 1:576 BOYSON ROAD NE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7206
Mailing Address - Country:US
Mailing Address - Phone:319-378-1515
Mailing Address - Fax:319-378-9292
Practice Address - Street 1:576 BOYSON ROAD NE
Practice Address - Street 2:SUITE 106
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-7206
Practice Address - Country:US
Practice Address - Phone:319-378-1515
Practice Address - Fax:319-378-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0494765Medicaid
IA0494773Medicaid