MEDICARE: KHADEEJA SMITH DC

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	S04086	MD

General Provider Information

NPI Number	:	1306502026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHADEEJA SMITH DC

Provider Business Mailing Address
First Line	:	14420 W SIDE BLVD APT 304
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-6270
Country	:	US
Telephone Number	:	516-402-0174
Fax Number	:

Provider Business Practice Location Address
First Line	:	8855 ANNAPOLIS RD STE 112
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-2962
Country	:	US
Telephone Number	:	301-284-8869
Fax Number	:

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

Provider Enumeration Date	:	11/17/2021
Last Update Date	:	11/17/2021

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Directions to “ KHADEEJA SMITH DC” Practice Location

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