=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699942151
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LATRETRA JOY SMITH-JONES DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2008
-----------------------------------------------------
Last Update Date | 01/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3202 N MAIN STREET SUITE 112 NELSON & NELSON CHIROPRACTIC
-----------------------------------------------------
City | HOPE MILLS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28348-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-426-9112
-----------------------------------------------------
Fax | 910-426-3802
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 502 POSSUM TROT LN
-----------------------------------------------------
City | HOPE MILLS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28348-9162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-920-1540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3849
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------