Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3848 | NC |
N | 111NS0005X | Chiropractic Sports Physician | 2008-072716 | SC |
NPI | 1073787206 |
---|---|
Provider Name | Dr. Christopher Dewaine Smith |
First Address | Simpsonville, SC 29681-5243 |
Second Address | Edenton, NC 27932-9553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2008 |
Last Update Date | 10/12/2008 |