Provider Demographics
NPI:1316273329
Name:SMITH, CECIL PAUL (DC)
Entity type:Individual
Prefix:
First Name:CECIL
Middle Name:PAUL
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 1:2695 VILLA CREEK DR
Mailing Address - Street 2:#145
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7328
Mailing Address - Country:US
Mailing Address - Phone:972-698-8888
Mailing Address - Fax:
Practice Address - Street 1:2695 VILLA CREEK DR
Practice Address - Street 2:#145
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7328
Practice Address - Country:US
Practice Address - Phone:972-698-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4518111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL53BOtherBLUE CROSS BLUE SHIELD