Provider Demographics
NPI:1124076567
Name:SMITH, GUY BATES (DC)
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:BATES
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:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AR
Mailing Address - Zip Code:72576-0306
Mailing Address - Country:US
Mailing Address - Phone:870-895-2606
Mailing Address - Fax:870-895-2607
Practice Address - Street 1:118 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:AR
Practice Address - Zip Code:72576-0306
Practice Address - Country:US
Practice Address - Phone:870-895-2606
Practice Address - Fax:870-895-2607
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR111747718Medicaid
ART20517Medicare UPIN
AR111747718Medicaid