Provider Demographics
NPI:1528093796
Name:SMITH, SUZAN JO (DC)
Entity type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:JO
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 1:3044 OLD DENTON RD
Mailing Address - Street 2:#316
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5016
Mailing Address - Country:US
Mailing Address - Phone:972-245-3377
Mailing Address - Fax:972-245-6366
Practice Address - Street 1:3044 OLD DENTON RD
Practice Address - Street 2:#316
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5016
Practice Address - Country:US
Practice Address - Phone:972-245-3377
Practice Address - Fax:972-245-6366
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4400111N00000X
FL5041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M0030OtherBCBS
T15953Medicare UPIN
TX8B6054Medicare PIN