Provider Demographics
NPI:1558427096
Name:SMITH, ROBERT WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
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 40362
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70835-0362
Mailing Address - Country:US
Mailing Address - Phone:225-291-2626
Mailing Address - Fax:225-291-2628
Practice Address - Street 1:4137 S SHERWOOD FOREST BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4377
Practice Address - Country:US
Practice Address - Phone:225-291-2626
Practice Address - Fax:225-291-2628
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA611111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1955558Medicaid
LA1955558Medicaid
LA59461Medicare ID - Type Unspecified