Provider Demographics
NPI:1033356381
Name:SIMPSON CHIROPRACTIC PAIN AND WELLNESS CENTER PA
Entity Type:Organization
Organization Name:SIMPSON CHIROPRACTIC PAIN AND WELLNESS CENTER PA
Other - Org Name:URGENT CARE CHIROPRACTIC PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-463-2344
Mailing Address - Street 1:464 SW PORT ST LUCIE BLVD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2077
Mailing Address - Country:US
Mailing Address - Phone:772-343-8511
Mailing Address - Fax:772-343-8585
Practice Address - Street 1:464 SW PORT ST LUCIE BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2077
Practice Address - Country:US
Practice Address - Phone:772-343-8511
Practice Address - Fax:772-343-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty