MEDICARE: DR. JOHN DOUGLAS SMILEY 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	2567	OK

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	:	1508893546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DOUGLAS SMILEY DC

Provider Business Mailing Address
First Line	:	PO BOX 1181
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-1181
Country	:	US
Telephone Number	:	918-422-6118
Fax Number	:	918-422-6192

Provider Business Practice Location Address
First Line	:	768 STATELINE RD
Second Line	:
City	:	COLCORD
State	:	OK
Zip	:	74338-1346
Country	:	US
Telephone Number	:	918-422-6118
Fax Number	:	918-422-6192

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	12/18/2008

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