Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | S01896 | MD |
NPI | 1003824228 |
---|---|
Provider Name | Dr. Lawrence G Smallwood |
First Address | Lusby, MD 20657-3196 |
Second Address | California, MD 20619-3138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 18/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U76337 | (02) | MD |