Individual
DR. CLINTON M SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
14015 JAMESTOWN RD, BREESE, IL 62230-3647
(618) 526-7732
Mailing address
14015 JAMESTOWN RD, BREESE, IL 62230-3647
(618) 526-7732
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038-006246
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001482004
BCBS IL
IL
01
—
37-1365531
TAX ID
IL
Enumeration date
06/23/2005
Last updated
11/21/2007
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