Provider Demographics
NPI:1508195090
Name:THOMAS G. SMITH, D.C., PLC
Entity Type:Organization
Organization Name:THOMAS G. SMITH, D.C., PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-552-0246
Mailing Address - Street 1:29856 SCHOENHERR RD.
Mailing Address - Street 2:STE 2
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088
Mailing Address - Country:US
Mailing Address - Phone:734-443-5000
Mailing Address - Fax:734-552-5002
Practice Address - Street 1:29856 SCHOENHERR RD.
Practice Address - Street 2:STE 2
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088
Practice Address - Country:US
Practice Address - Phone:734-443-5000
Practice Address - Fax:734-552-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H25054Medicare PIN