Jake Wayne Smith, D.C., M.S., B.S.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2016043441 Issued in MO

Practice address

1676 Bryan Rd Ste 111
Dardenne Prairie, MO 63368-4801

Phone

(314) 800-8609

Fax

(636) 385-6507

NPI assigned

Feb 19, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science, Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685404800000",
    "number": "1376902288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 SHADOW POINTE DR",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633853685",
            "telephone_number": "314-800-8609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1676 BRYAN RD STE 111",
            "city": "DARDENNE PRAIRIE",
            "state": "MO",
            "postal_code": "633684801",
            "telephone_number": "314-800-8609",
            "fax_number": "636-385-6507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JAKE",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "D.C., M.S., B.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-02-19",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "MO",
            "license": "2016043441",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2016043441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Dardenne Prairie, MO
• Providers in Dardenne Prairie, MO by specialty
• Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.