MEDICARE: DR. SADAT MALIK KWABENA SMITH DC, MS, DIBCN, DIBE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH7867	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013910462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SADAT MALIK KWABENA SMITH DC, MS, DIBCN, DIBE

Provider Business Mailing Address
First Line	:	927 S GOLDWYN AVE
Second Line	:	UNIT 220
City	:	ORLANDO
State	:	FL
Zip	:	32805-4324
Country	:	US
Telephone Number	:	407-574-8542
Fax Number	:	407-442-2071

Provider Business Practice Location Address
First Line	:	927 S GOLDWYN AVE
Second Line	:	UNIT 220
City	:	ORLANDO
State	:	FL
Zip	:	32805-4324
Country	:	US
Telephone Number	:	407-574-8542
Fax Number	:	407-442-2071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	12/11/2012

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