1588894828 NPI number — ADAM J SMITH D. C.

Table of content: ADAM J SMITH D. C. (NPI 1588894828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588894828 NPI number — ADAM J SMITH D. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
ADAM
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D. C.
Provider Gender Code:
M

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:
1588894828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 KIMBERLING SHRS
Provider Second Line Business Mailing Address:
APT 3
Provider Business Mailing Address City Name:
KIMBERLING CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65686-7418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-399-6893
Provider Business Mailing Address Fax Number:
417-739-9002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 KISSEE AVE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
KIMBERLING CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65686-9701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-739-9000
Provider Business Practice Location Address Fax Number:
417-739-9002
Provider Enumeration Date:
07/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2009019491 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2009019491 . This is a "LICENSE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com