Healthcare Provider Details

I. General information

NPI: 1205805975
Provider Name (Legal Business Name): GARY L SMITH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 NE 5TH AVE
CAMAS WA
98607-2033
US

IV. Provider business mailing address

337 NE 5TH AVE
CAMAS WA
98607-2030
US

V. Phone/Fax

Practice location:
  • Phone: 360-834-7533
  • Fax: 360-834-3084
Mailing address:
  • Phone: 360-834-7533
  • Fax: 360-834-3084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number27 2622
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00003521
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: