Provider Demographics
NPI:1154856268
Name:SIMARD, TANYA AMELIE (DC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:AMELIE
Last Name:SIMARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23252 ARROYO VIS
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2610
Mailing Address - Country:US
Mailing Address - Phone:949-264-6440
Mailing Address - Fax:
Practice Address - Street 1:23252 ARROYO VIS
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2610
Practice Address - Country:US
Practice Address - Phone:949-264-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33836111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology