Provider Demographics
NPI:1639434632
Name:GARY F SMITH DC
Entity Type:Organization
Organization Name:GARY F SMITH DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-474-6500
Mailing Address - Street 1:4210 W SYLVANIA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4501
Mailing Address - Country:US
Mailing Address - Phone:419-474-6500
Mailing Address - Fax:419-724-5463
Practice Address - Street 1:4210 W SYLVANIA AVE STE 102
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4501
Practice Address - Country:US
Practice Address - Phone:419-474-6500
Practice Address - Fax:419-724-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-06
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1647111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0911526Medicaid
OHSM0736895Medicare PIN