Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH13037 | FL |
NPI | 1003447665 |
---|---|
Provider Name | Matthew James Smith |
First Address | New Smyrna Beach, FL 32169-3628 |
Second Address | New Smyrna Beach, FL 32169-3628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2020 |
Last Update Date | 31/01/2020 |