Individual
DR. MARK S SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC PC
Contact information
Practice address
13549 MIDLOTHIAN TPKE, MIDLOTHIAN, VA 23113-4261
(804) 897-9194
(804) 794-3734
Mailing address
13354 MIDLOTHIAN TPKE, STE 100, MIDLOTHIAN, VA 23113-4258
(804) 744-5489
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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