Provider Demographics
NPI:1689758443
Name:SIMMONS SPECIFIC CHIROPRACTIC P C
Entity Type:Organization
Organization Name:SIMMONS SPECIFIC CHIROPRACTIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-923-2225
Mailing Address - Street 1:5108 EASTMAN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6823
Mailing Address - Country:US
Mailing Address - Phone:989-923-2225
Mailing Address - Fax:
Practice Address - Street 1:5108 EASTMAN AVE STE 1
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6823
Practice Address - Country:US
Practice Address - Phone:989-923-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007978111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4351677Medicaid
MI1265663033Medicaid
MI4718119Medicaid
MI4670338Medicaid
MI0N83260001Medicare PIN
MI0N8360007Medicare PIN
MIU78333Medicare UPIN
MIU98267Medicare UPIN
MI4670338Medicaid
MI0N8360003Medicare PIN
MI1265663033Medicaid