Healthcare Provider Details

I. General information

NPI: 1609982347
Provider Name (Legal Business Name): MORGAN FREDRICK SMITH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 NM-165 SUITE H
PLACITAS NM
87043
US

IV. Provider business mailing address

4 CALLE MONTOYA
PLACITAS NM
87043-9302
US

V. Phone/Fax

Practice location:
  • Phone: 505-808-4739
  • Fax: 888-974-6127
Mailing address:
  • Phone: 505-808-4739
  • Fax: 888-974-6127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC34105
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR0078
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC2264
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: