MEDICARE: DR. KEVIN WAYNE SMITH D.C.

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	9374	TX

General Provider Information

NPI Number	:	1609872613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN WAYNE SMITH D.C.

Provider Business Mailing Address
First Line	:	7015 SNIDER PLZ
Second Line	:	STE 225
City	:	DALLAS
State	:	TX
Zip	:	75205-5642
Country	:	US
Telephone Number	:	214-691-9355
Fax Number	:	214-691-9360

Provider Business Practice Location Address
First Line	:	7015 SNIDER PLZ
Second Line	:	STE 225
City	:	DALLAS
State	:	TX
Zip	:	75205-5642
Country	:	US
Telephone Number	:	214-691-9355
Fax Number	:	214-691-9360

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	02/28/2011

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