Healthcare Provider Details

I. General information

NPI: 1518938125
Provider Name (Legal Business Name): DOUGLAS JOEL SMITHSON DC PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3166 HWY 83 NO
SEELEY LAKE MT
59868-1195
US

IV. Provider business mailing address

PO BOX 1342
SEELEY LAKE MT
59868-1342
US

V. Phone/Fax

Practice location:
  • Phone: 406-677-2111
  • Fax:
Mailing address:
  • Phone: 406-677-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number293
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1256
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: