Provider Demographics
NPI:1285857839
Name:SMITH, DOUGLAS BRIAN JR (BS DC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:BRIAN
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:BS DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 OAK SPRINGS DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186
Mailing Address - Country:US
Mailing Address - Phone:540-349-8989
Mailing Address - Fax:540-349-8207
Practice Address - Street 1:225 OAK SPRINGS DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2428
Practice Address - Country:US
Practice Address - Phone:540-349-8989
Practice Address - Fax:540-349-8207
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA371661OtherANTHEM BCBS
VA00V504D72Medicare PIN