Provider Demographics
NPI:1174716237
Name:SMITH CHIROPRACTIC REHAB & WELLNESS CENTER PC
Entity type:Organization
Organization Name:SMITH CHIROPRACTIC REHAB & WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:T
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC DACNB
Authorized Official - Phone:209-723-6450
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:CAVALIER
Mailing Address - State:ND
Mailing Address - Zip Code:58220
Mailing Address - Country:US
Mailing Address - Phone:209-723-6450
Mailing Address - Fax:
Practice Address - Street 1:206 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220
Practice Address - Country:US
Practice Address - Phone:209-723-6450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
711272Medicare PIN