MEDICARE: LOGAN SMITH DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	B01661	NV

General Provider Information

NPI Number	:	1407372535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN SMITH DC

Provider Business Mailing Address
First Line	:	3613 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3344
Country	:	US
Telephone Number	:	702-570-9051
Fax Number	:	702-825-3641

Provider Business Practice Location Address
First Line	:	3613 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3344
Country	:	US
Telephone Number	:	702-570-9051
Fax Number	:	702-825-3641

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2017
Last Update Date	:	11/11/2025

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Directions to “ LOGAN SMITH DC” Practice Location

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