MEDICARE: REGENCY CHIROPRACTIC

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

General Provider Information

NPI Number	:	1225667652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENCY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	3165 BEAUMONT CENTRE CIR STE 130
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1966
Country	:	US
Telephone Number	:	859-219-1014
Fax Number	:	859-219-1017

Provider Business Practice Location Address
First Line	:	171 W LOWRY LN STE 164
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-3006
Country	:	US
Telephone Number	:	859-278-0083
Fax Number	:	859-278-0067

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. COLLIN P SMITH
Credential	:	DC
Telephone Number	:	859-219-1014

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	04/07/2020

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