Provider Demographics
NPI:1447447529
Name:ROBERT L SMITH DC
Entity type:Organization
Organization Name:ROBERT L SMITH DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-438-6007
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:UT
Mailing Address - Zip Code:84713-1088
Mailing Address - Country:US
Mailing Address - Phone:435-438-6007
Mailing Address - Fax:435-438-6007
Practice Address - Street 1:60 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:UT
Practice Address - Zip Code:84713
Practice Address - Country:US
Practice Address - Phone:435-438-6007
Practice Address - Fax:435-438-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4927914-1202261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health