Provider Demographics
NPI:1588643142
Name:SMITH, GREGORY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLEN
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 1:900 I ST
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-4313
Mailing Address - Country:US
Mailing Address - Phone:209-826-5865
Mailing Address - Fax:209-826-1571
Practice Address - Street 1:912 I ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-4313
Practice Address - Country:US
Practice Address - Phone:209-826-5865
Practice Address - Fax:209-826-1571
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT04605Medicare UPIN
CADC0120590Medicare ID - Type Unspecified