MEDICARE: DR. JOHN ALBERT SMITH D.C., CCSP,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	111NS0005X	Sports Physician Chiropractor	1412	NC

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	:	1992799332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ALBERT SMITH D.C., CCSP,PA

Provider Business Mailing Address
First Line	:	2926 CAPITAL BLVD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-3235
Country	:	US
Telephone Number	:	919-878-8848
Fax Number	:	919-878-8863

Provider Business Practice Location Address
First Line	:	2926 CAPITAL BLVD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-3235
Country	:	US
Telephone Number	:	919-878-8848
Fax Number	:	919-878-8863

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/08/2007

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