Provider Demographics
NPI:1386973790
Name:SMITH CHIROPRACTIC CENTER PA
Entity type:Organization
Organization Name:SMITH CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCST
Authorized Official - Phone:575-356-4440
Mailing Address - Street 1:1400 S AVE D STE A
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-6886
Mailing Address - Country:US
Mailing Address - Phone:575-356-4440
Mailing Address - Fax:575-356-4433
Practice Address - Street 1:1400 S AVE D STE A
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6886
Practice Address - Country:US
Practice Address - Phone:575-356-4440
Practice Address - Fax:575-356-4433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
614457900OtherDEPARTMENT OF LABOR
350023553OtherRAILROAD MEDICARE
NM201009423OtherPRESBYTERIAN
NMNM01K995OtherBCBS
U10159Medicare UPIN