Provider Demographics
NPI:1205049335
Name:SMITH, RICHARD M (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
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 1:59 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONSON
Mailing Address - State:MA
Mailing Address - Zip Code:01057
Mailing Address - Country:US
Mailing Address - Phone:413-267-0005
Mailing Address - Fax:
Practice Address - Street 1:59 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONSON
Practice Address - State:MA
Practice Address - Zip Code:01057
Practice Address - Country:US
Practice Address - Phone:413-267-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH2027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36443OtherBCBS
MAY36443OtherBCBS
U62982Medicare UPIN