MEDICARE: DR. KEVIN ROBERT SMITH D.C.

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	038011304	IL
2	111N00000X	Chiropractor	CH9212	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518901487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN ROBERT SMITH D.C.

Provider Business Mailing Address
First Line	:	1095 29TH AVE N
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34103-4560
Country	:	US
Telephone Number	:	239-272-9157
Fax Number	:

Provider Business Practice Location Address
First Line	:	1522 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-2528
Country	:	US
Telephone Number	:	312-379-5000
Fax Number	:	312-379-5060

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	11/12/2024

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