Provider Demographics
NPI:1962521377
Name:SIMMS, ERIK MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:MICHAEL
Last Name:SIMMS
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 1:11091 CLAY DR
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:KY
Mailing Address - Zip Code:41094-7473
Mailing Address - Country:US
Mailing Address - Phone:859-307-8779
Mailing Address - Fax:859-317-5481
Practice Address - Street 1:11091 CLAY DR
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:KY
Practice Address - Zip Code:41094-7473
Practice Address - Country:US
Practice Address - Phone:859-307-8779
Practice Address - Fax:859-317-5481
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007007863111N00000X
IN08002373A111N00000X
KY5234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK064140OtherMEDICARE PTAN