Blake Smith, DC
Individual provider Active NPI Chiropractor · Bixby, OK
NPI 1972379352 · NPPES record last updated Nov 28, 2023
Key facts
- NPI
- 1972379352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4490 (OK)
- Practice address
- 5085 E 151St St S Ste B
Bixby, OK 74008-4016 - Phone
- (918) 366-7100
- NPI assigned
- Nov 28, 2023
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4490 | OK | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Victory Spinal Care LLC | Chiropractor | Current |
Accepting new patients |
| Body Worx Chiropractic | Chiropractor | Past |
Accepting new patients |
Locations
1424 Kurre Ln
Cpe Girardeau, MO 63701
Phone (573) 334-0100
5085 E 151st St S
Ste B
Bixby, OK 74008
Phone (918) 366-7100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 4490 | OK | Yes |
Addresses
Primary practice location
5085 E 151St St S Ste B
Bixby, OK 74008-4016
Mailing address
5085 E 151St St S Ste B
Bixby, OK 74008-4016
Phone (918) 366-7100
Other providers in Bixby, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 28, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.