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General NPI Number Information
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NPI Number | 1518901487
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Entity Type | Individual
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Provider Name | KEVIN ROBERT SMITH D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 1522 N HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60642-2528
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Country | US
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Telephone | 312-379-5000
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Fax | 312-379-5060
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Provider Business Mailing Address
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Address Line | 1095 29TH AVE N
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City | NAPLES
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State | FL
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Zip | 34103-4560
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Country | US
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Telephone | 239-272-9157
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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 | 038011304
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH9212
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License Number State | FL
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