Provider Demographics
NPI:1154346187
Name:SMITH, TREK ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:TREK
Middle Name:ROBERT
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 1:1919 GLYNN AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-6140
Mailing Address - Country:US
Mailing Address - Phone:912-466-9945
Mailing Address - Fax:912-280-9490
Practice Address - Street 1:1919 GLYNN AVE STE 8
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-6140
Practice Address - Country:US
Practice Address - Phone:912-466-9945
Practice Address - Fax:912-280-9490
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00849098AMedicaid
GA00849098AMedicaid
GA35ZCFDSMedicare ID - Type Unspecified