Provider Demographics
NPI:1174699094
Name:SMITH, ROBERT JOSEPH (DC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOSEPH
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 1:831 BAY AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2168
Mailing Address - Country:US
Mailing Address - Phone:831-476-2225
Mailing Address - Fax:206-333-8770
Practice Address - Street 1:831 BAY AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2168
Practice Address - Country:US
Practice Address - Phone:831-476-2225
Practice Address - Fax:206-333-8770
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T05292Medicare UPIN
DC142420Medicare ID - Type Unspecified