Provider Demographics
NPI:1184636102
Name:SIMMONS, ROBERT LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
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 1:9484 BLACK MOUNTAIN RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4520
Mailing Address - Country:US
Mailing Address - Phone:858-566-2446
Mailing Address - Fax:858-566-2448
Practice Address - Street 1:9484 BLACK MOUNTAIN RD
Practice Address - Street 2:SUITE I
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4520
Practice Address - Country:US
Practice Address - Phone:858-566-2446
Practice Address - Fax:858-566-2448
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28430111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic