Provider Demographics
NPI:1043386121
Name:SMITH, GARRY JAMES (DC)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:JAMES
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 1:2515 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3697
Mailing Address - Country:US
Mailing Address - Phone:419-474-2363
Mailing Address - Fax:419-474-5856
Practice Address - Street 1:2515 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3697
Practice Address - Country:US
Practice Address - Phone:419-474-2363
Practice Address - Fax:419-474-5856
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor