Provider Demographics
NPI:1649771296
Name:SIMPSON, PRESTON OLIVER (DC)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:OLIVER
Last Name:SIMPSON
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 1:591 W 40 S
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-6129
Mailing Address - Country:US
Mailing Address - Phone:208-534-8823
Mailing Address - Fax:
Practice Address - Street 1:58 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-2128
Practice Address - Country:US
Practice Address - Phone:208-812-4044
Practice Address - Fax:208-218-9484
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor