Provider Demographics
NPI:1992749055
Name:SMITH, JAY H
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:H
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JAY
Other - Middle Name:H
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:151 N HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-5459
Mailing Address - Country:US
Mailing Address - Phone:610-326-4118
Mailing Address - Fax:610-326-7625
Practice Address - Street 1:151 N HANOVER ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5459
Practice Address - Country:US
Practice Address - Phone:610-326-4118
Practice Address - Fax:610-326-7625
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001229L111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic