Healthcare Provider Details

I. General information

NPI: 1417477688
Provider Name (Legal Business Name): DARREN SMITH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 04/24/2021
Certification Date: 04/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 MALL RING CIR STE 100
HENDERSON NV
89014-6666
US

IV. Provider business mailing address

69 GINGER LILY TER
HENDERSON NV
89074-1539
US

V. Phone/Fax

Practice location:
  • Phone: 702-990-2225
  • Fax:
Mailing address:
  • Phone: 971-340-9651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB01649
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberB01649
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: