Provider Demographics
NPI:1881725067
Name:SMITH FAMILY CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:SMITH FAMILY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-243-0700
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-0040
Mailing Address - Country:US
Mailing Address - Phone:580-243-0700
Mailing Address - Fax:580-243-0771
Practice Address - Street 1:2103 S MAIN ST STE N
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-9167
Practice Address - Country:US
Practice Address - Phone:580-243-0700
Practice Address - Fax:580-243-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK500522123Medicare ID - Type Unspecified