Provider Demographics
NPI:1063610780
Name:SIMMONS, STEVEN J (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:SIMMONS
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:PO BOX 2608
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-2608
Mailing Address - Country:US
Mailing Address - Phone:509-888-9000
Mailing Address - Fax:509-888-2412
Practice Address - Street 1:312 E TROW
Practice Address - Street 2:SUITE 200
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-9641
Practice Address - Country:US
Practice Address - Phone:509-888-9000
Practice Address - Fax:509-888-2412
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPIN G8867315Medicare PIN