Provider Demographics
NPI:1972504785
Name:SIMON CHIROPRACTIC, PC
Entity type:Organization
Organization Name:SIMON CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-860-6890
Mailing Address - Street 1:10245 E. VIA LINDA
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5316
Mailing Address - Country:US
Mailing Address - Phone:480-860-6890
Mailing Address - Fax:480-860-8583
Practice Address - Street 1:10245 E. VIA LINDA
Practice Address - Street 2:SUITE 112
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5316
Practice Address - Country:US
Practice Address - Phone:480-860-6890
Practice Address - Fax:480-860-8583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4158111N00000X
AZ4013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherFED TAX ID
AZWMBCPMedicare ID - Type Unspecified