Provider Demographics
NPI:1205805975
Name:SMITH, GARY L (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
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 1:337 NE 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2030
Mailing Address - Country:US
Mailing Address - Phone:360-834-7533
Mailing Address - Fax:360-834-3084
Practice Address - Street 1:337 NE 5TH AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2033
Practice Address - Country:US
Practice Address - Phone:360-834-7533
Practice Address - Fax:360-834-3084
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA27 2622111N00000X
WACH00003521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor