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General NPI Number Information
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NPI Number | 1023245248
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Entity Type | Organization
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Legal Business Name | SMITH FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 06/15/2009
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 5501 W HIGHWAY 290 SUITE B
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City | AUSTIN
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State | TX
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Zip | 78735-8803
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Country | US
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Telephone | 253-222-6409
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Fax |
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Provider Business Mailing Address
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Address Line | 5501 W HIGHWAY 290 SUITE B
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City | AUSTIN
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State | TX
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Zip | 78735-8803
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Country | US
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Telephone | 512-915-1413
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRENT SMITH
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Credential | D.C.
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Telephone | 512-915-1413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 11192
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License Number State | TX
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