=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689734832
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAWN CULBERT SMITH D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 MAIN ST SUITE 1
-----------------------------------------------------
City | MIDDLEBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-827-5585
-----------------------------------------------------
Fax | 518-827-7360
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 271
-----------------------------------------------------
City | MIDDLEBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12122-0271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-827-5585
-----------------------------------------------------
Fax | 518-827-7360
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 8025
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------