Provider Demographics
NPI:1699702399
Name:SMITH, JAY DARREN (DC)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:DARREN
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 1:2716 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3310
Mailing Address - Country:US
Mailing Address - Phone:330-453-7800
Mailing Address - Fax:330-454-8399
Practice Address - Street 1:2716 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3310
Practice Address - Country:US
Practice Address - Phone:330-453-7800
Practice Address - Fax:330-454-8399
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2093041Medicaid
OH0864441Medicare ID - Type Unspecified
OH2093041Medicaid