Provider Demographics
NPI:1396961751
Name:SMITH, GREGORY ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ROBERT
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 1:3431 CLEVELAND AVE
Mailing Address - Street 2:STE. G
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-2920
Mailing Address - Country:US
Mailing Address - Phone:614-784-0002
Mailing Address - Fax:614-784-0904
Practice Address - Street 1:3431 CLEVELAND AVE
Practice Address - Street 2:STE. G
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-2920
Practice Address - Country:US
Practice Address - Phone:614-784-0002
Practice Address - Fax:614-784-0904
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor