Provider Demographics
NPI:1447315924
Name:SMITH, CHARLES FRANKLIN (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FRANKLIN
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 1:233 N CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62681-1401
Mailing Address - Country:US
Mailing Address - Phone:217-322-4369
Mailing Address - Fax:217-322-4360
Practice Address - Street 1:233 N CONGRESS ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62681-1401
Practice Address - Country:US
Practice Address - Phone:217-322-4369
Practice Address - Fax:217-322-4360
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL273190Medicare ID - Type Unspecified