Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CHIA-681 | ID |
NPI | 1013067081 |
---|---|
Provider Name | Dr. Alan R Smith |
First Address | Rexburg, ID 83440-1926 |
Second Address | Rexburg, ID 83440-1926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001287600 | (05) | ID |
U36424 | (02) | ID |