Provider Demographics
NPI:1063424067
Name:SIMMONS CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:SIMMONS CHIROPRACTIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-566-2446
Mailing Address - Street 1:9484 BLACK MOUNTAIN RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4520
Mailing Address - Country:US
Mailing Address - Phone:858-566-2446
Mailing Address - Fax:858-566-2448
Practice Address - Street 1:9484 BLACK MOUNTAIN RD
Practice Address - Street 2:SUITE I
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4520
Practice Address - Country:US
Practice Address - Phone:858-566-2446
Practice Address - Fax:858-566-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28430111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty