Healthcare Provider Details

I. General information

NPI: 1316273329
Provider Name (Legal Business Name): CECIL PAUL SMITH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2695 VILLA CREEK DR #145
DALLAS TX
75234-7328
US

IV. Provider business mailing address

2695 VILLA CREEK DR #145
DALLAS TX
75234-7328
US

V. Phone/Fax

Practice location:
  • Phone: 972-698-8888
  • Fax:
Mailing address:
  • Phone: 972-698-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number4518
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: