Provider Demographics
NPI:1306996657
Name:SMITH, BENJAMIN WILSON III (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WILSON
Last Name:SMITH
Suffix:III
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 1:1801 DOUG BAKER BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4958
Mailing Address - Country:US
Mailing Address - Phone:205-536-7758
Mailing Address - Fax:205-536-7759
Practice Address - Street 1:1801 DOUG BAKER BLVD STE 115
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35242-4958
Practice Address - Country:US
Practice Address - Phone:205-536-7758
Practice Address - Fax:205-536-7759
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0083035OtherHEALTH SPRING
AL11495142OtherCAQH
AL7952010OtherCIGNA
AL51529981OtherBLUE CROSS BLUE SHIELD
AL668275OtherACN GROUP AND UNITED
AL7002756OtherAETNA
AL7952010OtherCIGNA
AL668275OtherACN GROUP AND UNITED