Provider Demographics
NPI:1437243300
Name:SIMONS, KEVIN T (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:SIMONS
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 1:830 20TH ST
Mailing Address - Street 2:APT 1
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-2102
Mailing Address - Country:US
Mailing Address - Phone:920-860-6426
Mailing Address - Fax:
Practice Address - Street 1:414 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-2912
Practice Address - Country:US
Practice Address - Phone:920-860-6426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3109-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00146537OtherRAILROAD MEDICARE
WI38888600Medicaid
U51053Medicare UPIN
WI000035585Medicare PIN