Healthcare Provider Details

I. General information

NPI: 1518523752
Provider Name (Legal Business Name): GRANT M SMITH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4161 S VERBENA ST
DENVER CO
80237-1747
US

IV. Provider business mailing address

6551 S REVERE PKWY STE 115
CENTENNIAL CO
80111-6410
US

V. Phone/Fax

Practice location:
  • Phone: 303-919-3767
  • Fax:
Mailing address:
  • Phone: 303-919-3767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHR.0008015
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: