Provider Demographics
NPI:1942397245
Name:SMITH, GARY ROBERT JR (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ROBERT
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:DC
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Mailing Address - Street 1:5660 CLINTON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9494
Mailing Address - Country:US
Mailing Address - Phone:716-686-0868
Mailing Address - Fax:716-686-0869
Practice Address - Street 1:5660 CLINTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059-9494
Practice Address - Country:US
Practice Address - Phone:716-686-0868
Practice Address - Fax:716-686-0869
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2008-05-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYX007938111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
U56216Medicare UPIN
11547BMedicare PIN