Individual provider Active NPI

Wayne Graham Smith, D.C.

  • Chiropractor
  • Saint Albans, VT
National Provider Identifier
1750343992
Registry record updated Jul 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
006.0064013 Issued in VT
Practice address
158 Lake St
Saint Albans, VT 05478-2278
Phone
(864) 494-3555
Fax
(802) 782-8862
NPI assigned
Apr 4, 2006
Last updated
Jul 13, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 006.0064013 VT Primary
Nutrition Chiropractor 111NN1001X 06.0064013 VT
Rehabilitation Chiropractor 111NR0400X 06.0064013 VT

Addresses

Primary practice location

158 Lake St
Saint Albans, VT 05478-2278

Mailing address

5129 Ethan Allen Hwy
Saint Albans, VT 05478-6071
Phone (864) 494-3555

Other identifiers 3

IdentifierTypeStateIssuer
001617502OtherVTMEDICARE PTAN
GCH365MedicaidSC
CH2393MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2393SCMDProfessional Counselor
006.0064013VTMDChiropractor
06.0064013VTMDNutrition Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Skylyn Wellness Center, Inc. Chiropractor Past Accepting new patients
Back to Health Family Chiropractic, P.C. Chiropractor PastSince Feb 15, 2010 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342137600000",
    "number": "1750343992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5129 ETHAN ALLEN HWY",
            "city": "SAINT ALBANS",
            "state": "VT",
            "postal_code": "054786071",
            "telephone_number": "864-494-3555",
            "fax_number": "802-782-8862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 LAKE ST",
            "city": "SAINT ALBANS",
            "state": "VT",
            "postal_code": "054782278",
            "telephone_number": "864-494-3555",
            "fax_number": "802-782-8862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "WAYNE",
        "middle_name": "GRAHAM",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-04",
        "last_updated": "2012-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VT",
            "license": "006.0064013",
            "primary": true
        },
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "VT",
            "license": "06.0064013",
            "primary": false
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "VT",
            "license": "06.0064013",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "001617502",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GCH365",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CH2393",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Albans, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2012; 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.