Healthcare Provider Details

I. General information

NPI: 1649221920
Provider Name (Legal Business Name): SMOKY MOUNTAIN CHIROPRACTIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 HIGHWAY 19 S SUITE 3
BRYSON CITY NC
28713-9513
US

IV. Provider business mailing address

PO BOX 1728
BRYSON CITY NC
28713-1728
US

V. Phone/Fax

Practice location:
  • Phone: 828-488-9033
  • Fax: 828-488-6442
Mailing address:
  • Phone: 282-488-9033
  • Fax: 828-488-6442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1795
License Number StateNC

VIII. Authorized Official

Name: DR. SCOTT A. MARTIN
Title or Position: PRESIDENT
Credential: DC
Phone: 828-488-9033