Provider Demographics
NPI:1316974710
Name:SMITH, WALTON ARIAIL (CHIROPRACTOR)
Entity type:Individual
Prefix:
First Name:WALTON
Middle Name:ARIAIL
Last Name:SMITH
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SLIDE HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29832
Mailing Address - Country:US
Mailing Address - Phone:803-275-2225
Mailing Address - Fax:803-275-9333
Practice Address - Street 1:101 SLIDE HILL ROAD
Practice Address - Street 2:JOHNSTON CHIRPORACTIC CLINIC
Practice Address - City:JOHNSTON
Practice Address - State:SC
Practice Address - Zip Code:29832
Practice Address - Country:US
Practice Address - Phone:803-275-2225
Practice Address - Fax:803-275-9333
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1334Medicaid