Provider Demographics
NPI:1982753463
Name:SIMMONS, JIMMY ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:ALLEN
Last Name:SIMMONS
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 1:108 STERLING ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-6415
Mailing Address - Country:US
Mailing Address - Phone:936-258-5020
Mailing Address - Fax:936-257-8565
Practice Address - Street 1:108 STERLING ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-6415
Practice Address - Country:US
Practice Address - Phone:936-258-5020
Practice Address - Fax:936-257-8565
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K2690OtherBCBS PROVIDER #
TX8K2690OtherBCBS PROVIDER #
TXU98996Medicare UPIN