Provider Demographics
NPI:1407064116
Name:SMITH, ROBERT DENNIS JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DENNIS
Last Name:SMITH
Suffix:JR
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 1:1201 ROUTE 37 E
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-5728
Mailing Address - Country:US
Mailing Address - Phone:732-929-2333
Mailing Address - Fax:732-929-2333
Practice Address - Street 1:1201 ROUTE 37 E
Practice Address - Street 2:SUITE 3
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-5728
Practice Address - Country:US
Practice Address - Phone:732-929-2333
Practice Address - Fax:732-929-2333
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC01394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091612Medicare ID - Type Unspecified