Provider Demographics
NPI:1376654673
Name:SMITH, TONY ROY (DC)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:ROY
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 1:905 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76932-3201
Mailing Address - Country:US
Mailing Address - Phone:325-884-1100
Mailing Address - Fax:325-884-1150
Practice Address - Street 1:905 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:TX
Practice Address - Zip Code:76932-3201
Practice Address - Country:US
Practice Address - Phone:325-884-1100
Practice Address - Fax:325-884-1150
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU53076Medicare UPIN
8F1051Medicare PIN