Healthcare Provider Details

I. General information

NPI: 1508893546
Provider Name (Legal Business Name): JOHN DOUGLAS SMILEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 STATELINE RD
COLCORD OK
74338-1346
US

IV. Provider business mailing address

PO BOX 1181
SILOAM SPRINGS AR
72761-1181
US

V. Phone/Fax

Practice location:
  • Phone: 918-422-6118
  • Fax: 918-422-6192
Mailing address:
  • Phone: 918-422-6118
  • Fax: 918-422-6192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2567
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: