Provider Demographics
NPI:1427158138
Name:SMITH, RYAN ALEXANDER (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ALEXANDER
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 1:36434 U.S. HIGHWAY 19 NORTH
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684
Mailing Address - Country:US
Mailing Address - Phone:727-785-6771
Mailing Address - Fax:727-781-1428
Practice Address - Street 1:36434 U.S. HIGHWAY 19 NORTH
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684
Practice Address - Country:US
Practice Address - Phone:727-785-6771
Practice Address - Fax:727-781-1428
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8144111N00000X
NYX009395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2800187-00Medicaid
FL53959OtherBCBSFL
002244711OtherUHC
002244711OtherUHC
FL53959OtherBCBSFL