Provider Demographics
NPI:1346311784
Name:SMITH, ROBIN WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:WILLIAM
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 1:1042 MORGANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-4357
Mailing Address - Country:US
Mailing Address - Phone:130-436-6126
Mailing Address - Fax:130-436-6126
Practice Address - Street 1:1042 MORGANTOWN AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-4357
Practice Address - Country:US
Practice Address - Phone:130-436-6126
Practice Address - Fax:130-436-6126
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSMO387131Medicare ID - Type Unspecified
WVT32250Medicare UPIN