Spine and Sport of Slidell, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

SPINE AND SPORT OF SLIDELL, LLC

Practice address

436 Old Spanish TRL
Slidell, LA 70458-3904

Phone

(985) 641-4898

NPI assigned

May 17, 2024

Organization subpart

No

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

Authorized official

Name

Kyle W Smith, DCNPI 1811386949

Title

Owner

Phone

(985) 290-0893

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kyle William Smith, D.C

  • Chiropractor
  • Slidell, LA
  • NPI 1811386949
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1715904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715904000000",
    "number": "1457100729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 N CALEB DR",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704615713",
            "telephone_number": "985-290-0893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 OLD SPANISH TRL",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704583904",
            "telephone_number": "985-641-4898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE AND SPORT OF SLIDELL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-17",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-290-0893",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Slidell, LA
• Providers in Slidell, LA by specialty
• Chiropractor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.