MEDICARE: DR. MARK C 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	08001934A	IN

General Provider Information

NPI Number	:	1457477663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK C SMITH DC

Provider Business Mailing Address
First Line	:	1632 LINCOLN WAY E
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46544-2918
Country	:	US
Telephone Number	:	574-256-2635
Fax Number	:	574-256-0030

Provider Business Practice Location Address
First Line	:	1632 LINCOLN WAY E
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46544-2918
Country	:	US
Telephone Number	:	574-256-2635
Fax Number	:	574-256-0030

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. MARK C SMITH DC” Practice Location

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