Healthcare Provider Details

I. General information

NPI: 1285630434
Provider Name (Legal Business Name): BRIAN ALBERT SMITH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/02/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12746 PARKBURY DRIVE
ORLANDO FL
32828
US

IV. Provider business mailing address

12746 PARKBURY DRIVE
ORLANDO FL
32828
US

V. Phone/Fax

Practice location:
  • Phone: 407-457-2800
  • Fax: 518-684-8526
Mailing address:
  • Phone: 407-457-2800
  • Fax: 518-684-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License NumberDC18647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: