Provider Demographics
NPI:1073618195
Name:SMITH, REBECCA DAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:DAWN
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:DAWN
Other - Last Name:VAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2103 S MAIN ST STE N
Mailing Address - Street 2:PO BOX 40
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-9167
Mailing Address - Country:US
Mailing Address - Phone:580-243-0700
Mailing Address - Fax:580-243-0771
Practice Address - Street 1:2103 S MAIN ST STE N
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-9167
Practice Address - Country:US
Practice Address - Phone:580-243-0700
Practice Address - Fax:580-243-0771
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK245529302Medicare ID - Type Unspecified