Provider Demographics
NPI:1639160690
Name:SMITH, MAURICE WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:WILLIAM
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 1:357 WARNER MILNE RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4045
Mailing Address - Country:US
Mailing Address - Phone:503-655-6780
Mailing Address - Fax:503-655-6206
Practice Address - Street 1:357 WARNER MILNE RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4045
Practice Address - Country:US
Practice Address - Phone:503-655-6780
Practice Address - Fax:503-655-6206
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 1312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR184648Medicaid
ORQGBKJMedicare ID - Type Unspecified
OR184648Medicaid