Provider Demographics
NPI:1619299625
Name:ROBERT M SMITH DC PC
Entity Type:Organization
Organization Name:ROBERT M SMITH DC PC
Other - Org Name:CHIROPRACTIC WHOLE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-438-2015
Mailing Address - Street 1:3413 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7642
Mailing Address - Country:US
Mailing Address - Phone:610-438-2015
Mailing Address - Fax:610-438-2016
Practice Address - Street 1:3413 SULLIVAN TRL
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-7642
Practice Address - Country:US
Practice Address - Phone:610-438-2015
Practice Address - Fax:610-438-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007400L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000489080OtherBC/BS ASSIGNMENT
23-3009-371OtherUNITED/PRIVATE/DEVON
0089992000OtherKHPE/PERS CHOICE/B
2282278OtherAETNA
0830943000OtherKHPE/PERS CHOICE/B
5897870OtherGHI
02726200OtherCAPITAL BLUE CROSS
3354341OtherCIGNA
1032114OtherASHN
3Y2380OtherLANDMARK HEALTH NET
PA0018774340002Medicaid
P00351498OtherRAILROAD MEDICINE
1813282OtherFIRST HEALTH
447411OtherBS PROVIDER
P2821922OtherOXFORD HEALTH
447411OtherBS PROVIDER