Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 1961 | NM |
NPI | 1265514632 |
---|---|
Provider Name | Jonathan D Smith |
First Address | Las Cruces, NM 88011-8288 |
Second Address | Las Cruces, NM 88005-3242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 30/01/2018 |