Healthcare Provider Details

I. General information

NPI: 1831143296
Provider Name (Legal Business Name): ROBERT THOMAS SMITH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 W SAGINAW RD
SANFORD MI
48657-9689
US

IV. Provider business mailing address

PO BOX 469
SANFORD MI
48657-0469
US

V. Phone/Fax

Practice location:
  • Phone: 989-687-7376
  • Fax:
Mailing address:
  • Phone: 989-687-7376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301002881
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: