MEDICARE: DR. LEE JOSEPH 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	06478	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37388	OTHER	IA	BLUE CROSS BLUE SHEILD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790843936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE JOSEPH SMITH DC

Provider Business Mailing Address
First Line	:	2728 ASBURY RD
Second Line	:	STE. 920
City	:	DUBUQUE
State	:	IA
Zip	:	52001-2971
Country	:	US
Telephone Number	:	563-582-5185
Fax Number	:	563-582-3075

Provider Business Practice Location Address
First Line	:	2728 ASBURY RD
Second Line	:	STE. 920
City	:	DUBUQUE
State	:	IA
Zip	:	52001-2971
Country	:	US
Telephone Number	:	563-582-5185
Fax Number	:	563-582-3075

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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