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General NPI Number Information
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NPI Number | 1891579199
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Entity Type | Organization
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Legal Business Name | BACKSMITH LLC
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 2680 COBB PKWY NW STE C
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City | KENNESAW
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State | GA
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Zip | 30152-3470
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Country | US
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Telephone | 770-629-9885
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Fax | 770-430-8750
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Provider Business Mailing Address
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Address Line | 2680 COBB PKWY NW STE C
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City | KENNESAW
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State | GA
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Zip | 30152-3470
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Country | US
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Telephone | 770-629-9885
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Fax | 770-430-8750
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN CHARLES SMITH JR.
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Credential | DC
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Telephone | 770-629-9885
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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 |
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License Number State |
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