Provider Demographics
NPI:1215941356
Name:SMITH, KEVIN M (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1699 WASHINGTON RD STE 401
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1629
Mailing Address - Country:US
Mailing Address - Phone:412-595-7332
Mailing Address - Fax:724-871-1588
Practice Address - Street 1:1699 WASHINGTON RD STE 401
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228-1629
Practice Address - Country:US
Practice Address - Phone:412-595-7332
Practice Address - Fax:724-871-1588
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADC8622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1339603OtherBLUE CROSS BLUE SHIELD