Provider Demographics
NPI:1730254343
Name:SMITH FAMILY CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:SMITH FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:REED
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:228-586-9343
Mailing Address - Street 1:PO BOX 1447
Mailing Address - Street 2:
Mailing Address - City:KILN
Mailing Address - State:MS
Mailing Address - Zip Code:39556-1447
Mailing Address - Country:US
Mailing Address - Phone:228-586-9343
Mailing Address - Fax:228-586-9341
Practice Address - Street 1:16195 HIGHWAY 603
Practice Address - Street 2:
Practice Address - City:KILN
Practice Address - State:MS
Practice Address - Zip Code:39556-8269
Practice Address - Country:US
Practice Address - Phone:228-586-9343
Practice Address - Fax:228-586-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05088327Medicaid
MS08432735Medicaid
MS08432735Medicaid
MS350000342Medicare PIN