Provider Demographics
NPI:1194898841
Name:SMITH, JEFFREY S (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
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 1:101 S 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844
Mailing Address - Country:US
Mailing Address - Phone:863-422-1351
Mailing Address - Fax:863-422-7499
Practice Address - Street 1:101 S 10TH STREET
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844
Practice Address - Country:US
Practice Address - Phone:863-422-1351
Practice Address - Fax:863-422-7499
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70517Medicare ID - Type Unspecified
FLT64418Medicare UPIN