Provider Demographics
NPI:1356497895
Name:FLETCHER, DAVID SIMPSON (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SIMPSON
Last Name:FLETCHER
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 1:1323 DARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-2006
Mailing Address - Country:US
Mailing Address - Phone:765-362-9231
Mailing Address - Fax:765-362-6086
Practice Address - Street 1:1323 DARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-2006
Practice Address - Country:US
Practice Address - Phone:765-362-9231
Practice Address - Fax:765-362-6086
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000636A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN35-1466736Medicare UPIN
555-670Medicare ID - Type Unspecified