Individual
DR. KEVIN CHARLES SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC CCSP
Contact information
Practice address
2875 HOLME AVE, PHILADELPHIA, PA 19152
(215) 673-1113
(215) 673-4941
Mailing address
2875 HOLME AVE, PHILADELPHIA, PA 19152
(215) 673-1113
(215) 673-4941
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC003171L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0061028000
INDEPENDENCE BLUE CROSS
PA
05
—
1514680
—
PA
Enumeration date
05/04/2006
Last updated
04/09/2013
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