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General NPI Number Information
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NPI Number | 1447288071
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Entity Type | Individual
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Provider Name | JOHN SMITH JR. DC
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 249 CLARKSON RD #101
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City | ELLISVILLE
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State | MO
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Zip | 63011-2219
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Country | US
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Telephone | 636-256-0707
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Fax |
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Provider Business Mailing Address
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Address Line | 249 CLARKSON RD # 101
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City | ELLISVILLE
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State | MO
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Zip | 63011-2497
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Country | US
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Telephone | 636-256-0707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6547
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License Number State | MO
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