Healthcare Provider Details

I. General information

NPI: 1669480901
Provider Name (Legal Business Name): LAURENCE N SMITH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10464 E NORTHWEST HWY
DALLAS TX
75238-4608
US

IV. Provider business mailing address

10464 E NORTHWEST HWY
DALLAS TX
75238-4608
US

V. Phone/Fax

Practice location:
  • Phone: 214-341-9373
  • Fax: 214-341-0620
Mailing address:
  • Phone: 214-341-9373
  • Fax: 214-341-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4765
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: