Provider Demographics
NPI:1346472404
Name:SIMMONS, DARBY ELIZABETH (DC)
Entity Type:Individual
Prefix:MISS
First Name:DARBY
Middle Name:ELIZABETH
Last Name:SIMMONS
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 1:4715B MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1950
Mailing Address - Country:US
Mailing Address - Phone:304-925-5003
Mailing Address - Fax:304-925-5004
Practice Address - Street 1:4715B MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1950
Practice Address - Country:US
Practice Address - Phone:304-925-5003
Practice Address - Fax:304-925-5004
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV910111N00000X, 111N00000X
SC3430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor