Provider Demographics
NPI:1679530364
Name:SMITH, DOUGLAS MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MARTIN
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 1:716 SW GAYLORD AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-7425
Mailing Address - Country:US
Mailing Address - Phone:580-248-9712
Mailing Address - Fax:580-248-9812
Practice Address - Street 1:7007 NW CACHE RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-2707
Practice Address - Country:US
Practice Address - Phone:580-536-4844
Practice Address - Fax:580-536-4890
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKT83429Medicare ID - Type Unspecified