Provider Demographics
NPI:1992783427
Name:SMITH, JEFFREY RAYMOND (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:RAYMOND
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 1:1300 SE 14TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6814
Mailing Address - Country:US
Mailing Address - Phone:479-271-6992
Mailing Address - Fax:471-271-6993
Practice Address - Street 1:1300 SE 14TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6814
Practice Address - Country:US
Practice Address - Phone:479-271-6992
Practice Address - Fax:471-271-6993
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350054931OtherRAILROAD MEDICARE
U69036Medicare UPIN
350054931OtherRAILROAD MEDICARE