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General NPI Number Information
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NPI Number | 1821180266
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Entity Type | Individual
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Provider Name | STEPHAN JOHN SMITH DC
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11319 SOUTH SAGINAW STREET
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City | GRAND BLANC
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State | MI
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Zip | 48439-1268
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Country | US
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Telephone | 810-694-2200
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Fax | 810-694-6750
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Provider Business Mailing Address
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Address Line | 11319 SOUTH SAGINAW STREET
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City | GRAND BLANC
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State | MI
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Zip | 48439-1268
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Country | US
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Telephone | 810-694-2200
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Fax | 810-694-6750
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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 | 2301007830
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License Number State | MI
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