Provider Demographics
NPI:1619191020
Name:SMITH, SR., NORMAN RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:RICHARD
Last Name:SMITH, SR.
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 1:385 MAIN ST.
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-0163
Mailing Address - Country:US
Mailing Address - Phone:207-594-2224
Mailing Address - Fax:207-354-6853
Practice Address - Street 1:385 MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-3370
Practice Address - Country:US
Practice Address - Phone:207-594-2224
Practice Address - Fax:207-354-6853
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MET31443Medicare UPIN