MEDICARE: DR. SUZAN J. SMITH CHIROPRACTIC PA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0071KZ	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1598985004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. SUZAN J. SMITH CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	3044 OLD DENTON RD
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5016
Country	:	US
Telephone Number	:	972-245-3377
Fax Number	:	972-245-6366

Provider Business Practice Location Address
First Line	:	3044 OLD DENTON RD
Second Line	:	SUITE 316
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5016
Country	:	US
Telephone Number	:	972-245-3377
Fax Number	:	972-245-6366

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SUZAN JO SMITH
Credential	:	DC
Telephone Number	:	972-245-3377

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	02/06/2008

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Directions to “DR. SUZAN J. SMITH CHIROPRACTIC PA ” Practice Location

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