Provider Demographics
NPI:1194803874
Name:SIMPSON, PHILIP RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:RICHARD
Last Name:SIMPSON
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 1:1191 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1349
Mailing Address - Country:US
Mailing Address - Phone:606-886-1416
Mailing Address - Fax:606-886-8849
Practice Address - Street 1:1191 S LAKE DR
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1349
Practice Address - Country:US
Practice Address - Phone:606-886-1416
Practice Address - Fax:606-886-8849
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3079-R111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6040101Medicare ID - Type UnspecifiedPROVIDER NUMBER