Healthcare Provider Details

I. General information

NPI: 1033202916
Provider Name (Legal Business Name): LARRY R SMITH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 RICHMOND ST
MT VERNON KY
40456-0593
US

IV. Provider business mailing address

235 RICHMOND STREET POB 593
MT VERNON KY
40456-0593
US

V. Phone/Fax

Practice location:
  • Phone: 606-256-0242
  • Fax:
Mailing address:
  • Phone: 606-256-0242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4003
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: