Provider Demographics
NPI:1144309626
Name:SMOLENSKY, DAVID ALBERT (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALBERT
Last Name:SMOLENSKY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:SMOLENSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 1138
Mailing Address - Street 2:129 GRAND AVE
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046
Mailing Address - Country:US
Mailing Address - Phone:724-625-3711
Mailing Address - Fax:724-625-3099
Practice Address - Street 1:129 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-1138
Practice Address - Country:US
Practice Address - Phone:724-625-3711
Practice Address - Fax:724-625-3099
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003418L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA120323Medicare UPIN
PA530001Medicare ID - Type Unspecified