Provider Demographics
NPI:1588788111
Name:SMITH, JEFFREY WINSTON (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WINSTON
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:PO BOX 1910
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-0109
Mailing Address - Country:US
Mailing Address - Phone:541-810-2332
Mailing Address - Fax:541-205-3822
Practice Address - Street 1:2041 RADCLIFFE AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-3322
Practice Address - Country:US
Practice Address - Phone:541-810-2332
Practice Address - Fax:541-205-3822
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24901111N00000X
OR3647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U68552Medicare UPIN
DC0249010Medicare ID - Type Unspecified