Provider Demographics
NPI:1407289838
Name:SIMPLY CHIROPRACTIC
Entity Type:Organization
Organization Name:SIMPLY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:POULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-868-8202
Mailing Address - Street 1:2113 N MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-7763
Mailing Address - Country:US
Mailing Address - Phone:435-868-8202
Mailing Address - Fax:435-865-1500
Practice Address - Street 1:2113 N MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-7763
Practice Address - Country:US
Practice Address - Phone:435-868-8202
Practice Address - Fax:435-865-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8572868-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366783847OtherPERSOANAL NPI