Provider Demographics
NPI:1487661922
Name:SMITH, LAWRENCE RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:RICHARD
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:PO BOX 1990
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754-1990
Mailing Address - Country:US
Mailing Address - Phone:828-689-3777
Mailing Address - Fax:828-689-5435
Practice Address - Street 1:342 CARL ELLER RD
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:NC
Practice Address - Zip Code:28754-1990
Practice Address - Country:US
Practice Address - Phone:828-689-3777
Practice Address - Fax:828-689-5435
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08430OtherBC/BS
NC8908430Medicaid
NC08430OtherBC/BS
NCT64525Medicare UPIN