Provider Demographics
NPI:1104898089
Name:SIMS, JEANNETTE DENISE (DC)
Entity type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:DENISE
Last Name:SIMS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:JEANNETTE
Other - Middle Name:DENISE
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3602 S MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8430
Mailing Address - Country:US
Mailing Address - Phone:813-837-5050
Mailing Address - Fax:813-837-7100
Practice Address - Street 1:3602 S MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8430
Practice Address - Country:US
Practice Address - Phone:813-837-5050
Practice Address - Fax:813-837-7100
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL350050710OtherRAILROAD
FL381440800Medicaid
4840170001Medicare UPIN
FL381440800Medicaid