Provider Demographics
NPI:1629300306
Name:SIMON, DAVID (LAC, AP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:LAC, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 2ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIAN ROCKS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33785-2910
Mailing Address - Country:US
Mailing Address - Phone:727-595-8901
Mailing Address - Fax:
Practice Address - Street 1:1808 2ND ST
Practice Address - Street 2:
Practice Address - City:INDIAN ROCKS BEACH
Practice Address - State:FL
Practice Address - Zip Code:33785-2910
Practice Address - Country:US
Practice Address - Phone:727-595-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2659171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist