Healthcare Provider Details

I. General information

NPI: 1174125900
Provider Name (Legal Business Name): NATHAN LUKE SMITH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 LAWNDALE DR STE 108
GREENSBORO NC
27408-4129
US

IV. Provider business mailing address

2800 LAWNDALE DR STE 108
GREENSBORO NC
27408-4129
US

V. Phone/Fax

Practice location:
  • Phone: 336-331-8464
  • Fax: 336-331-8464
Mailing address:
  • Phone: 336-331-8464
  • Fax: 336-331-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5786
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: