1730254343 NPI number — SMITH FAMILY CHIROPRACTIC PLLC

Table of content: CHERE VASSELL RN, MSN (NPI 1619333895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730254343 NPI number — SMITH FAMILY CHIROPRACTIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMITH FAMILY CHIROPRACTIC PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730254343
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1447
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39556-1447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-586-9343
Provider Business Mailing Address Fax Number:
228-586-9341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16195 HIGHWAY 603
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KILN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39556-8269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-586-9343
Provider Business Practice Location Address Fax Number:
228-586-9341
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
REED
Authorized Official Title or Position:
MEMBER-OWNER
Authorized Official Telephone Number:
228-586-9343

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1085 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05088327 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08432735 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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