Provider Demographics
NPI:1710123831
Name:SMART, GREGORY W (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:W
Last Name:SMART
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 1:2700 FINDLEY DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4279
Mailing Address - Country:US
Mailing Address - Phone:309-846-1215
Mailing Address - Fax:
Practice Address - Street 1:3330 HEDLEY RD
Practice Address - Street 2:SUITE C
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-6476
Practice Address - Country:US
Practice Address - Phone:217-726-0151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011302111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition