Provider Demographics
NPI:1871750331
Name:DR. GRANT K. SMITH DC CHIROPRACTIC CENTERS, LLC
Entity type:Organization
Organization Name:DR. GRANT K. SMITH DC CHIROPRACTIC CENTERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:REED
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-621-2224
Mailing Address - Street 1:715 BELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4514
Mailing Address - Country:US
Mailing Address - Phone:251-621-2224
Mailing Address - Fax:251-621-2225
Practice Address - Street 1:715 BELROSE AVE
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4514
Practice Address - Country:US
Practice Address - Phone:251-621-2224
Practice Address - Fax:251-621-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1140111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68578Medicare UPIN