Provider Demographics
NPI:1245200930
Name:SMITH, ROBERT M (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
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 1:3413 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7642
Mailing Address - Country:US
Mailing Address - Phone:610-438-2015
Mailing Address - Fax:610-438-2016
Practice Address - Street 1:3413 SULLIVAN TRL
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-7642
Practice Address - Country:US
Practice Address - Phone:610-438-2015
Practice Address - Fax:610-438-2016
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007400L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1813282OtherFIRST HEALTH
2282278OtherAETNA
3Y2380OtherLANDMARK/HEALTHNET/ACS
P2821992OtherOXFORD
PA02726200OtherCBC(CAPITAL BLUE CROSS)
PA447411OtherBS/HIGHMARK
PA489080OtherBS/HIGHMARK
58997870OtherGHI
1032114OtherASHN
PA1877434Medicaid
0089992000OtherBS/KEYSTONE EAST
PA447411OtherBS/HIGHMARK
U76175Medicare UPIN