Provider Demographics
NPI:1912484247
Name:SIAHMAKOUN, SIMEON (DC)
Entity type:Individual
Prefix:DR
First Name:SIMEON
Middle Name:
Last Name:SIAHMAKOUN
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 1:4760 GALLERIA PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-9613
Mailing Address - Country:US
Mailing Address - Phone:775-339-9499
Mailing Address - Fax:775-339-9511
Practice Address - Street 1:4760 GALLERIA PKWY STE 108
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-9613
Practice Address - Country:US
Practice Address - Phone:775-339-9499
Practice Address - Fax:775-339-9511
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor