Individual
PHILLIP L SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
12320 HIGHWAY 44 STE A, GONZALES, LA 70737-2202
(225) 644-8671
(225) 644-6427
Mailing address
12320 HIGHWAY 44 STE A, GONZALES, LA 70737-2202
(225) 644-8671
(225) 644-6427
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
369
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1951781
—
LA
01
—
200062121
STATE GRP PROVIDER NUMBER
LA
01
—
G6933
B/C PROVIDER NUMBER
LA
Enumeration date
04/06/2006
Last updated
07/21/2010
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