Provider Demographics
NPI:1033515762
Name:SMITH, GREGORY ALLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 S TELEPHONE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2972
Mailing Address - Country:US
Mailing Address - Phone:405-793-8777
Mailing Address - Fax:405-793-1089
Practice Address - Street 1:2900 S TELEPHONE RD STE 150
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2972
Practice Address - Country:US
Practice Address - Phone:405-793-8777
Practice Address - Fax:405-793-1089
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33138111N00000X
OK4177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor