Individual
MR. MICHAEL SCOTT SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
108 S FRANKLIN ST, DWIGHT, IL 60420-1345
(815) 584-2225
Mailing address
PO BOX 151, DWIGHT, IL 60420-0151
(815) 584-2225
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
038-008658
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03223254
BLUE CROSS BLUE SHIELD
IL
01
—
551250
MEDICARE PTAN
—
Enumeration date
02/27/2007
Last updated
04/21/2020
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