Healthcare Provider Details

I. General information

NPI: 1104028687
Provider Name (Legal Business Name): NORMAN ALAN SMITH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 MAIN ST
PINEVILLE MO
64856
US

IV. Provider business mailing address

PO BOX 37 307 MAIN ST
PINEVILLE MO
64856
US

V. Phone/Fax

Practice location:
  • Phone: 417-223-4103
  • Fax: 417-223-4102
Mailing address:
  • Phone: 417-223-4103
  • Fax: 417-223-4102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number003822
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: