Provider Demographics
NPI:1629003884
Name:SMITH, LAURENCE RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:RYAN
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 1:1700 RANCH ROAD 620 N STE 108
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-2788
Mailing Address - Country:US
Mailing Address - Phone:737-359-0888
Mailing Address - Fax:512-727-5658
Practice Address - Street 1:1700 RANCH ROAD 620 N STE 108
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-2788
Practice Address - Country:US
Practice Address - Phone:737-359-0888
Practice Address - Fax:512-727-5658
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC1021111N00000X
TX10965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000252254OtherBCBS
H100460Medicare ID - Type Unspecified