Provider Demographics
NPI:1578567467
Name:SMITH, CHESTER Y (DC)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:Y
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 1530
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-1530
Mailing Address - Country:US
Mailing Address - Phone:512-446-5844
Mailing Address - Fax:512-446-5850
Practice Address - Street 1:1512 W CAMERON AVE
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2607
Practice Address - Country:US
Practice Address - Phone:512-446-5844
Practice Address - Fax:512-446-5850
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2287111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT15975Medicare UPIN
TX600993Medicare ID - Type Unspecified