Provider Demographics
NPI:1275682155
Name:SIMON, MITCHELL STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:STEVEN
Last Name:SIMON
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 1:45 MAIN ST APT 605
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2964
Mailing Address - Country:US
Mailing Address - Phone:816-810-9722
Mailing Address - Fax:
Practice Address - Street 1:45 MAIN ST APT 605
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2964
Practice Address - Country:US
Practice Address - Phone:816-810-9722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33091111N00000X
NY013165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34764017OtherBCBS
MO34764017OtherBCBS