Provider Demographics
NPI:1184730467
Name:SMITH, ROGER A (DC)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:A
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 1:7313 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3607
Mailing Address - Country:US
Mailing Address - Phone:301-473-8863
Mailing Address - Fax:
Practice Address - Street 1:286 MONTEVUE LN
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-8212
Practice Address - Country:US
Practice Address - Phone:301-662-4220
Practice Address - Fax:301-662-8195
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01320111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD565M875FMedicare ID - Type UnspecifiedPROVIDER ID