Smith, Russell Shane
Smith, Russell Shane is an sole proprietor health care provider with primary practice located at 2175 Chambliss Ave Nw Suite D, Cleveland TN 37311-3842. He recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as his primary health care specialty. Smith, Russell Shane can be contacted via phone (423) 472-1140.Contact Information
Primary practice address
2175 Chambliss Ave Nw Suite D
Cleveland TN 37311-3842
Phone: (423) 472-1140
Fax: (423) 339-2242
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Chiropractor | 111N00000X | 595 | Tennessee |
Profile Details
| NPI number | 1316912058 |
|---|---|
| LBN Legal business name | Smith, Russell Shane |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 17th, 2006 |
| Last updated | Dec 2nd, 2009 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316912058 | NPPES |
| Tennessee | Other | 84739 | BLUE CROSS |
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