Provider Demographics
NPI:1023585429
Name:SMITH, GABRIEL LEE (DC)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:GABRIEL
Other - Middle Name:LEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GABRIEL SMITH DC
Mailing Address - Street 1:605 G AVE
Mailing Address - Street 2:
Mailing Address - City:GRUNDY CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50638-1549
Mailing Address - Country:US
Mailing Address - Phone:319-825-4400
Mailing Address - Fax:319-825-4401
Practice Address - Street 1:605 G AVE
Practice Address - Street 2:
Practice Address - City:GRUNDY CENTER
Practice Address - State:IA
Practice Address - Zip Code:50638-1549
Practice Address - Country:US
Practice Address - Phone:319-825-4400
Practice Address - Fax:877-300-8998
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty