Provider Demographics
NPI:1285307868
Name:SMITH CHIROPRACTIC GROUP, PLLC
Entity type:Organization
Organization Name:SMITH CHIROPRACTIC GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:DEWAINE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-370-3180
Mailing Address - Street 1:744 US HIGHWAY 64 E
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-9313
Mailing Address - Country:US
Mailing Address - Phone:252-793-9600
Mailing Address - Fax:252-793-9736
Practice Address - Street 1:744 US HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-9313
Practice Address - Country:US
Practice Address - Phone:252-793-9600
Practice Address - Fax:252-793-9736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty