Provider Demographics
NPI:1447434949
Name:SMITH, KEVIN T (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 NEWARK AVE
Mailing Address - Street 2:#308
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1326
Mailing Address - Country:US
Mailing Address - Phone:201-239-9500
Mailing Address - Fax:201-239-8200
Practice Address - Street 1:550 NEWARK AVE
Practice Address - Street 2:#308
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1326
Practice Address - Country:US
Practice Address - Phone:201-239-9500
Practice Address - Fax:201-239-8200
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00259500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor