Individual
KELLY WADE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
104 W LINCOLN AVE, FERGUS FALLS, MN 56537-2123
(218) 736-4113
(218) 998-4337
Mailing address
104 W LINCOLN AVE, FERGUS FALLS, MN 56537-2123
(218) 736-4113
(218) 998-4337
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3250
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
231907
CHIROCARE
MN
01
—
4C542SM
BLUE CROSS/BLUE SHIELD
MN
Enumeration date
09/30/2005
Last updated
02/27/2008
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