Healthcare Provider Details
I. General information
NPI: 1730198748
Provider Name (Legal Business Name): SMITH CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/07/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
322 4TH AVE SE
HILLSBORO ND
58045-4905
US
IV. Provider business mailing address
322 4TH AVE SE
HILLSBORO ND
58045-4905
US
V. Phone/Fax
- Phone: 701-636-4606
- Fax:
- Phone: 701-636-4606
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261Q00000X |
| Taxonomy | Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
AIMEE
LYNNE
SMITH
Title or Position: PRESIDENT/OWNER
Credential: D.C.
Phone: 701-636-4606