Provider Demographics
NPI:1427183599
Name:SMITH, ERIC LEE (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LEE
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 1:26 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-1209
Mailing Address - Country:US
Mailing Address - Phone:740-852-5100
Mailing Address - Fax:740-852-5281
Practice Address - Street 1:26 E HIGH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1209
Practice Address - Country:US
Practice Address - Phone:740-852-5100
Practice Address - Fax:740-852-5281
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2040535Medicaid
OHU68629Medicare UPIN
OH2040535Medicaid