Provider Demographics
NPI:1528024437
Name:SMITH, DONNA GAYLE (DC)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:GAYLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:MCVAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:301 N LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47872-1522
Mailing Address - Country:US
Mailing Address - Phone:765-569-3129
Mailing Address - Fax:765-569-3120
Practice Address - Street 1:301 N LINCOLN RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47872-1522
Practice Address - Country:US
Practice Address - Phone:765-569-3129
Practice Address - Fax:765-569-3120
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002004A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200354810AMedicaid
000000306343OtherANTHEM
000000306343OtherANTHEM