Provider Demographics
NPI:1396079729
Name:SMITH, AMBER D (DC)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 N MAIN ST
Mailing Address - Street 2:P.O. BOX 264
Mailing Address - City:MONTGOMERY
Mailing Address - State:IN
Mailing Address - Zip Code:47558-4526
Mailing Address - Country:US
Mailing Address - Phone:812-486-2577
Mailing Address - Fax:812-486-2574
Practice Address - Street 1:439 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IN
Practice Address - Zip Code:47558-4526
Practice Address - Country:US
Practice Address - Phone:812-486-2577
Practice Address - Fax:812-486-2574
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002468A111N00000X
KY5110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor