MEDICARE: DR. DARREN A SMITH DC, DACBSP

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	111NS0005X	Sports Physician Chiropractor	3049	OR

General Provider Information

NPI Number	:	1962576348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARREN A SMITH DC, DACBSP

Provider Business Mailing Address
First Line	:	2930 NW IVY LN
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-7958
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4829 NE MLK BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-3491
Country	:	US
Telephone Number	:	360-635-2525
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	02/23/2012

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