Healthcare Provider Details

I. General information

NPI: 1447447529
Provider Name (Legal Business Name): ROBERT L SMITH DC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 N MAIN ST
BEAVER UT
84713
US

IV. Provider business mailing address

PO BOX 1088
BEAVER UT
84713-1088
US

V. Phone/Fax

Practice location:
  • Phone: 435-438-6007
  • Fax: 435-438-6007
Mailing address:
  • Phone: 435-438-6007
  • Fax: 435-438-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number4927914-1202
License Number StateUT

VIII. Authorized Official

Name: DR. ROBERT L SMITH
Title or Position: PRESIDENT
Credential: DC
Phone: 435-438-6007