Provider Demographics
NPI:1417024217
Name:SMITH, KEVIN CURTIS (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CURTIS
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 1:212 FULTON
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066
Mailing Address - Country:US
Mailing Address - Phone:651-388-3212
Mailing Address - Fax:651-385-0255
Practice Address - Street 1:212 FULTON
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066
Practice Address - Country:US
Practice Address - Phone:651-388-3212
Practice Address - Fax:651-385-0255
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2046111N00000X
WI1594111N00000X
FLCH0003658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN060228100Medicaid
70D31SMOtherBCBS
MN060228100Medicaid
350000653Medicare ID - Type Unspecified