Provider Demographics
NPI:1982780003
Name:SMITH, STEWART WORLAND III (DC)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:WORLAND
Last Name:SMITH
Suffix:III
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 1:15082 DENWOODS CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7001
Mailing Address - Country:US
Mailing Address - Phone:636-532-9907
Mailing Address - Fax:
Practice Address - Street 1:543 E FERGUSON AVE
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-2103
Practice Address - Country:US
Practice Address - Phone:618-254-2273
Practice Address - Fax:618-254-8476
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL103146OtherHEALTHLINK
IL038004647Medicaid
MO1599054OtherBC&BS OF MO
IL6015405OtherBC&BS OF IL
IL6015405OtherBC&BS OF IL
IL038004647Medicaid