Healthcare Provider Details

I. General information

NPI: 1578797619
Provider Name (Legal Business Name): SMITH CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 E 20TH ST
FARMINGTON NM
87401-4309
US

IV. Provider business mailing address

1707 E 20TH ST
FARMINGTON NM
87401-4309
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-5086
  • Fax: 505-324-0139
Mailing address:
  • Phone: 505-327-5086
  • Fax: 505-324-0139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1144
License Number StateNM

VIII. Authorized Official

Name: DR. MARTIN ALBERT SMITH
Title or Position: PRESIDENT
Credential: D.C.
Phone: 505-327-5086