Provider Demographics
NPI:1124244942
Name:SMITH, DUANE H (DC)
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:H
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 1:1520 N UNION BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2840
Mailing Address - Country:US
Mailing Address - Phone:719-632-1333
Mailing Address - Fax:719-632-1333
Practice Address - Street 1:1520 N UNION BLVD STE 101
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2840
Practice Address - Country:US
Practice Address - Phone:719-632-1333
Practice Address - Fax:719-632-1333
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA102455Medicare PIN