MEDICARE: SMITH CHIROPRACTIC CARE PLLC

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	:	1417156688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITH CHIROPRACTIC CARE PLLC

Provider Business Mailing Address
First Line	:	531 WASHINGTON ST
Second Line	:	SUITE 3101
City	:	WATERTOWN
State	:	NY
Zip	:	13601-4084
Country	:	US
Telephone Number	:	315-788-9001
Fax Number	:	315-788-9001

Provider Business Practice Location Address
First Line	:	531 WASHINGTON ST
Second Line	:	SUITE 3101
City	:	WATERTOWN
State	:	NY
Zip	:	13601-4084
Country	:	US
Telephone Number	:	315-788-9001
Fax Number	:	315-788-9001

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD WENDELL SMITH
Credential	:	DC
Telephone Number	:	315-788-9001

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	07/17/2007

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