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General NPI Number Information
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NPI Number | 1174796288
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Entity Type | Organization
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Legal Business Name | SMART CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 708 BRIDGE ST
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City | PARK RAPIDS
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State | MN
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Zip | 56470-1215
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Country | US
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Telephone | 218-732-7261
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 208
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City | PARK RAPIDS
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State | MN
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Zip | 56470-0208
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Country | US
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Telephone | 218-732-7261
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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. TRACY JON SMART
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Credential |
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Telephone | 218-732-7261
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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 |
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License Number State | MN
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