Provider Demographics
NPI:1942490545
Name:MICHAEL W. SMITH D.C. LTD
Entity type:Organization
Organization Name:MICHAEL W. SMITH D.C. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-230-7246
Mailing Address - Street 1:266 33RD AVE S STE 7
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4685
Mailing Address - Country:US
Mailing Address - Phone:320-230-7246
Mailing Address - Fax:320-230-7256
Practice Address - Street 1:266 33RD AVE S STE 7
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4685
Practice Address - Country:US
Practice Address - Phone:320-230-7246
Practice Address - Fax:320-230-7256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN606K6SMOtherBC/BS
MNP00355696OtherMEDICARE RAIL ROAD
MN606K6SMOtherBC/BS
MNC04201Medicare PIN