Healthcare Provider Details

I. General information

NPI: 1801705850
Provider Name (Legal Business Name): GARRETT KENNAMER SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 AR-74
ELKINS AR
72727
US

IV. Provider business mailing address

1119 RIVER OAKS ST
ELKINS AR
72727-8474
US

V. Phone/Fax

Practice location:
  • Phone: 479-240-2471
  • Fax:
Mailing address:
  • Phone: 479-240-2471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12501
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: