Provider Demographics
NPI:1154591899
Name:SMITH CHIROPRACTIC CLINIC, PLLC
Entity type:Organization
Organization Name:SMITH CHIROPRACTIC CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:TROY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:731-584-7224
Mailing Address - Street 1:258 W MAIN ST
Mailing Address - Street 2:B
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-1644
Mailing Address - Country:US
Mailing Address - Phone:731-584-7224
Mailing Address - Fax:731-584-7226
Practice Address - Street 1:258 W MAIN ST
Practice Address - Street 2:B
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1644
Practice Address - Country:US
Practice Address - Phone:731-584-7224
Practice Address - Fax:731-584-7226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2245261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center