MEDICARE: CAYLEE JORDAN SMITH D.C

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	15767	TX

General Provider Information

NPI Number	:	1326826835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAYLEE JORDAN SMITH D.C

Provider Business Mailing Address
First Line	:	10761 FOUNDERS WY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-1574
Country	:	US
Telephone Number	:	469-540-7158
Fax Number	:

Provider Business Practice Location Address
First Line	:	10761 FOUNDERS WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-1574
Country	:	US
Telephone Number	:	325-998-5500
Fax Number	:

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

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	09/18/2023

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