Provider Demographics
NPI:1124188529
Name:SMITH, ROBIN LOUISE (DC)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:LOUISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 N BALLAS RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2314
Mailing Address - Country:US
Mailing Address - Phone:314-872-9955
Mailing Address - Fax:314-872-3458
Practice Address - Street 1:2821 N BALLAS RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2321
Practice Address - Country:US
Practice Address - Phone:314-872-9955
Practice Address - Fax:314-872-3458
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE006676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU74225Medicare UPIN
MO31676Medicare ID - Type Unspecified