Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | IL |
NPI | 1003852799 |
---|---|
Provider Name | Dr. Jeffrey M Smith |
First Address | Elmwood Park, IL 60707-4123 |
Second Address | Elmwood Park, IL 60707-4123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 08/07/2007 |