Provider Demographics
NPI:1417964313
Name:SIMEONE, RICHARD V (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:V
Last Name:SIMEONE
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 1:18 FORK ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT POCONO
Mailing Address - State:PA
Mailing Address - Zip Code:18344-1202
Mailing Address - Country:US
Mailing Address - Phone:570-839-9402
Mailing Address - Fax:570-839-9473
Practice Address - Street 1:18 FORK ST
Practice Address - Street 2:
Practice Address - City:MOUNT POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344-1202
Practice Address - Country:US
Practice Address - Phone:570-839-9402
Practice Address - Fax:570-839-9473
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003780L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA805805OtherFIRST PRIORITY
PA9625100OtherGHI
PA4417175OtherAETNA
PA829777OtherAETNA US HEALTHCARE
PA434259Medicare ID - Type Unspecified
PA805805OtherFIRST PRIORITY