Provider Demographics
NPI:1053346700
Name:SMITH, MICHAEL VERNON (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VERNON
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 BAY AREA BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2627
Mailing Address - Country:US
Mailing Address - Phone:281-480-9931
Mailing Address - Fax:
Practice Address - Street 1:1020 BAY AREA BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2627
Practice Address - Country:US
Practice Address - Phone:281-480-9931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5599111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603302Medicare PIN