Provider Demographics
NPI:1336268812
Name:SMITH, DALE FORD (DC)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:FORD
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 1:7981 DEXTER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-8798
Mailing Address - Country:US
Mailing Address - Phone:901-794-0876
Mailing Address - Fax:901-794-0854
Practice Address - Street 1:7981 DEXTER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-8798
Practice Address - Country:US
Practice Address - Phone:901-794-0876
Practice Address - Fax:901-794-0854
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3026681OtherBLUE CROSS BLUE SHIELD
TN2423005OtherCIGNA
TNU55115Medicare UPIN
TN3677768Medicare ID - Type Unspecified