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General NPI Number Information
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NPI Number | 1881038537
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Entity Type | Organization
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Legal Business Name | ALAN R SMITH DC PA
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Dates
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Enumeration Date | 04/24/2013
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 57 E MAIN ST
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City | REXBURG
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State | ID
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Zip | 83440-1959
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Country | US
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Telephone | 208-359-2313
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Fax | 208-359-2313
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Provider Business Mailing Address
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Address Line | 57 E MAIN ST
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City | REXBURG
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State | ID
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Zip | 83440-1959
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Country | US
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Telephone | 208-359-2313
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Fax | 208-359-2313
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALAN SMITH
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Credential | D.C. P.A.
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Telephone | 208-359-2313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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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 | CHIA-681
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License Number State | ID
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