Provider Demographics
NPI:1194727313
Name:SIMONE, MICHAEL P (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:SIMONE
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 1:1111 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-1702
Mailing Address - Country:US
Mailing Address - Phone:303-833-2332
Mailing Address - Fax:
Practice Address - Street 1:1111 1ST ST
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621-1702
Practice Address - Country:US
Practice Address - Phone:303-833-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4506111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT21624Medicare UPIN
COC48443Medicare PIN