Provider Demographics
NPI:1316097876
Name:SIMPSON, JENNIFER LESLIE (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LESLIE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 BROAD ST
Mailing Address - Street 2:STE 106
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-1123
Mailing Address - Country:US
Mailing Address - Phone:734-424-0162
Mailing Address - Fax:
Practice Address - Street 1:10424 PELHAM RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180
Practice Address - Country:US
Practice Address - Phone:313-291-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor