Provider Demographics
NPI:1699450239
Name:SMITH, ELIAS DANIEL (DC)
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:DANIEL
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 1:217 RIDGE MILL CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-1776
Mailing Address - Country:US
Mailing Address - Phone:913-963-2104
Mailing Address - Fax:
Practice Address - Street 1:1203 COTTON GROVE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-5264
Practice Address - Country:US
Practice Address - Phone:336-697-6398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023015495111N00000X
NC5737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor