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Individual
DR. MARK S SMITH
Active
Individual
DR. MARK S SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC PC
Taxonomy
Speciality
Code
Description
License number
State
111NN0400X
Neurology Chiropractor
Primary
0104000196
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
177764
ANTHEM BC/BS ID
VA
01
—
541182330
AETNA PROVIDER ID
VA
Enumeration date
10/06/2006
Last updated
10/27/2016
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