Provider Demographics
NPI:1558448233
Name:SMITH, TROY R (DC)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4922 BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3901
Mailing Address - Country:US
Mailing Address - Phone:423-499-8834
Mailing Address - Fax:423-899-8193
Practice Address - Street 1:4922 BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3901
Practice Address - Country:US
Practice Address - Phone:423-499-8834
Practice Address - Fax:423-899-8193
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3031125OtherBLUE CROSS
TNU459449Medicare UPIN
TN3678161Medicare ID - Type Unspecified