MEDICARE: DR. GREGORY ROBERT SMITH 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	2744	OH

General Provider Information

NPI Number	:	1396961751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY ROBERT SMITH D.C.

Provider Business Mailing Address
First Line	:	3431 CLEVELAND AVE
Second Line	:	STE. G
City	:	COLUMBUS
State	:	OH
Zip	:	43224-2920
Country	:	US
Telephone Number	:	614-784-0002
Fax Number	:	614-784-0904

Provider Business Practice Location Address
First Line	:	3431 CLEVELAND AVE
Second Line	:	STE. G
City	:	COLUMBUS
State	:	OH
Zip	:	43224-2920
Country	:	US
Telephone Number	:	614-784-0002
Fax Number	:	614-784-0904

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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