Provider Demographics
NPI:1689748097
Name:SIMMONS, DAVID WESLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WESLEY
Last Name:SIMMONS
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 1:117 E LIVE OAK AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5269
Mailing Address - Country:US
Mailing Address - Phone:626-446-4066
Mailing Address - Fax:626-446-4065
Practice Address - Street 1:117 E LIVE OAK AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-5269
Practice Address - Country:US
Practice Address - Phone:626-446-4066
Practice Address - Fax:626-446-4065
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC013390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC013390Medicare ID - Type Unspecified
CADC013390Medicare UPIN