Provider Demographics
NPI:1376723312
Name:DOUGLAS SMITH, PC
Entity Type:Organization
Organization Name:DOUGLAS SMITH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:540-349-8989
Mailing Address - Street 1:332 W LEE HWY
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2428
Mailing Address - Country:US
Mailing Address - Phone:540-349-8989
Mailing Address - Fax:540-349-8207
Practice Address - Street 1:332 W LEE HWY
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA371661OtherANTHEM BCBS
VAC08772Medicare PIN