Provider Demographics
NPI:1912939059
Name:SMITH, JAMES DICKEY (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DICKEY
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 N WOODBINE RD
Mailing Address - Street 2:PO BOX 6423
Mailing Address - City:ST JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506
Mailing Address - Country:US
Mailing Address - Phone:816-232-5113
Mailing Address - Fax:816-232-0453
Practice Address - Street 1:1802 N WOODBINE RD
Practice Address - Street 2:
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-232-5113
Practice Address - Fax:816-232-0453
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00120973OtherRR MEDICARE
MO75385310Medicaid
MO10001164203OtherCOMMUNITY HEALTH PLAN
MOK759058Medicare ID - Type Unspecified
MOP00120973OtherRR MEDICARE