Provider Demographics
NPI:1518901487
Name:SMITH, KEVIN ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ROBERT
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 29TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4560
Mailing Address - Country:US
Mailing Address - Phone:239-272-9157
Mailing Address - Fax:
Practice Address - Street 1:1522 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2528
Practice Address - Country:US
Practice Address - Phone:312-379-5000
Practice Address - Fax:312-379-5060
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011304111N00000X
FLCH9212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213964OtherBCBS-IL