Provider Demographics
NPI:1083102867
Name:SIMONS, JENNIFER COLLENE (DC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:COLLENE
Last Name:SIMONS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:COLLENE
Other - Last Name:PARGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11481 SW HALL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8403
Mailing Address - Country:US
Mailing Address - Phone:503-941-9912
Mailing Address - Fax:503-941-9915
Practice Address - Street 1:11481 SW HALL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8403
Practice Address - Country:US
Practice Address - Phone:503-941-9912
Practice Address - Fax:503-941-9915
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor