Provider Demographics
NPI:1902911621
Name:SMITH, JANE PALMER (DC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:PALMER
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 333
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-0333
Mailing Address - Country:US
Mailing Address - Phone:937-456-4555
Mailing Address - Fax:
Practice Address - Street 1:890 S BARRON ST
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-9362
Practice Address - Country:US
Practice Address - Phone:937-456-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2174936Medicaid
OH000000198866OtherBCBS ANTHEM
OH7529172OtherAETNA
OHU74385Medicare UPIN
OH7529172OtherAETNA