Healthcare Provider Details

I. General information

NPI: 1093297426
Provider Name (Legal Business Name): DELIA SMITH DC, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2018
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 MILWAUKEE ST STE 240
SAINT LOUIS MO
63122-7360
US

IV. Provider business mailing address

10 E 68TH TER
KANSAS CITY MO
64113-2464
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-1502
  • Fax:
Mailing address:
  • Phone: 816-914-8157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7117
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2020009473
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3692
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2023046993
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: