Provider Demographics
NPI:1053434977
Name:SMITH, RONALD G (DC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RONALD
Other - Middle Name:G
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1250 S MAIN ST
Mailing Address - Street 2:STE 1A
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1453
Mailing Address - Country:US
Mailing Address - Phone:734-475-8669
Mailing Address - Fax:734-475-0304
Practice Address - Street 1:1250 S MAIN ST
Practice Address - Street 2:STE 1A
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1453
Practice Address - Country:US
Practice Address - Phone:734-475-8669
Practice Address - Fax:734-475-0304
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARS006610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor