Provider Demographics
NPI:1154371573
Name:SMITH, GARY F (DC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:F
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 1:1574 HENTHORNE DR STE C
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-3921
Mailing Address - Country:US
Mailing Address - Phone:419-517-1737
Mailing Address - Fax:419-517-0108
Practice Address - Street 1:1574 HENTHORNE DR STE C
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-3921
Practice Address - Country:US
Practice Address - Phone:419-517-1737
Practice Address - Fax:419-517-0108
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000208590OtherANTHEM PIN#
OH0911526Medicaid
OH350051747OtherRAILROAD MEDICARE
OH0911526Medicaid
OHSMO736895Medicare ID - Type Unspecified