Provider Demographics
NPI:1134679020
Name:RONALD G. SMITH, D.C., PLLC
Entity type:Organization
Organization Name:RONALD G. SMITH, D.C., PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-433-9000
Mailing Address - Street 1:1250 S MAIN ST
Mailing Address - Street 2:STE. 1A
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1453
Mailing Address - Country:US
Mailing Address - Phone:734-433-9000
Mailing Address - Fax:734-433-9009
Practice Address - Street 1:1250 S MAIN ST
Practice Address - Street 2:STE. 1A
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1453
Practice Address - Country:US
Practice Address - Phone:734-433-9000
Practice Address - Fax:734-433-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1712Medicare UPIN