Provider Demographics
NPI:1194801431
Name:SMITH, MURRAY ALDEN (DC)
Entity type:Individual
Prefix:DR
First Name:MURRAY
Middle Name:ALDEN
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:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:DEERWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56444-0340
Mailing Address - Country:US
Mailing Address - Phone:952-807-2613
Mailing Address - Fax:
Practice Address - Street 1:15354 DELLWOOD DR STE 110
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-6940
Practice Address - Country:US
Practice Address - Phone:952-807-2613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN109523400OtherMEDICAL ASSISTANT
MN3C156GAOtherBLUE CROSS/BLUE SHIELD
MN109523400OtherMEDICAL ASSISTANT
MN359000163Medicare PIN