Provider Demographics
NPI:1992737803
Name:SMITH, KEVIN C (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:C
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 1:1903 GRANT AVE
Mailing Address - Street 2:STE. B
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6134
Mailing Address - Country:US
Mailing Address - Phone:870-336-3333
Mailing Address - Fax:870-336-3332
Practice Address - Street 1:1903 GRANT AVE
Practice Address - Street 2:STE. B
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6134
Practice Address - Country:US
Practice Address - Phone:870-336-3333
Practice Address - Fax:870-336-3332
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001974111N00000X
AR15986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor