MEDICARE: DR. OLIVER ROY SMITH III D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	11286	TX

General Provider Information

NPI Number	:	1194048850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLIVER ROY SMITH III D.C.

Provider Business Mailing Address
First Line	:	1417 BROWN ST.
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902
Country	:	US
Telephone Number	:	915-533-2225
Fax Number	:	915-533-0974

Provider Business Practice Location Address
First Line	:	1417 BROWN ST.
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902
Country	:	US
Telephone Number	:	915-533-2225
Fax Number	:	915-533-0974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2010
Last Update Date	:	03/10/2010

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