Provider Demographics
NPI:1538430442
Name:SMITH, DEREK PARKER (DC)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:PARKER
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 1:2109 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-4137
Mailing Address - Country:US
Mailing Address - Phone:870-248-0646
Mailing Address - Fax:870-248-0645
Practice Address - Street 1:2109 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-4137
Practice Address - Country:US
Practice Address - Phone:870-248-0646
Practice Address - Fax:870-248-0645
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor