Provider Demographics
NPI:1174666531
Name:SMITH, ROBERT KEITH (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KEITH
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 1:340 CLEVELAND AVE
Mailing Address - Street 2:PO BOX 358
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1004
Mailing Address - Country:US
Mailing Address - Phone:607-324-2444
Mailing Address - Fax:607-324-2524
Practice Address - Street 1:340 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1004
Practice Address - Country:US
Practice Address - Phone:607-324-2444
Practice Address - Fax:607-324-2524
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC028763OtherWORKERS COMPENSATION
NYC028763OtherWORKERS COMPENSATION