Provider Demographics
NPI:1841465093
Name:MARK E SMITH DC
Entity type:Organization
Organization Name:MARK E SMITH DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-653-5507
Mailing Address - Street 1:1095 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1933
Mailing Address - Country:US
Mailing Address - Phone:810-653-5507
Mailing Address - Fax:810-658-8210
Practice Address - Street 1:1095 S STATE RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1933
Practice Address - Country:US
Practice Address - Phone:810-653-5507
Practice Address - Fax:810-658-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS005682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIXX14476OtherHEALTH PLUS
MI950B51400OtherBLUE CROSS
MI142733170Medicaid
MI142733170Medicaid
MIU16953Medicare UPIN