Provider Demographics
NPI:1982929196
Name:SMITH CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SMITH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:915-533-2225
Mailing Address - Street 1:1417 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4752
Mailing Address - Country:US
Mailing Address - Phone:915-533-2225
Mailing Address - Fax:915-533-0974
Practice Address - Street 1:1417 BROWN ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4752
Practice Address - Country:US
Practice Address - Phone:915-533-2225
Practice Address - Fax:915-533-0974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2406OtherTEXAS STATE CHIROPRACTIC LICENSE