Healthcare Provider Details

I. General information

NPI: 1801800271
Provider Name (Legal Business Name): CLIFFORD CORNELIUS SMITH II D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 GLENN AVE
WEST LIBERTY KY
41472-1119
US

IV. Provider business mailing address

PO BOX 88
WEST LIBERTY KY
41472-0088
US

V. Phone/Fax

Practice location:
  • Phone: 606-743-3617
  • Fax: 606-743-9790
Mailing address:
  • Phone: 606-743-3617
  • Fax: 606-743-9790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3718
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: