MEDICARE: L. LEE SMITH, D.C, P.A

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	CH7178	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

General Provider Information

NPI Number	:	1336424506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L. LEE SMITH, D.C, P.A

Provider Business Mailing Address
First Line	:	220 N BABCOCK ST
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-6717
Country	:	US
Telephone Number	:	321-327-7014
Fax Number	:	321-821-1924

Provider Business Practice Location Address
First Line	:	100 W NEW HAVEN AVE
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-4303
Country	:	US
Telephone Number	:	321-327-7014
Fax Number	:	321-821-1924

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. LARRY LEE SMITH
Credential	:	D.C
Telephone Number	:	321-327-7014

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	09/09/2020

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