Provider Demographics
NPI:1457411423
Name:SMITH, THOMAS L (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
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 1:365 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-4852
Mailing Address - Country:US
Mailing Address - Phone:330-262-0971
Mailing Address - Fax:330-263-0972
Practice Address - Street 1:365 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-4852
Practice Address - Country:US
Practice Address - Phone:330-262-0971
Practice Address - Fax:330-263-0972
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0242320Medicaid
SM0390623Medicare ID - Type Unspecified