Provider Demographics
NPI:1710003892
Name:SIMPSON, IAN KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:KEITH
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 1:210 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2204
Mailing Address - Country:US
Mailing Address - Phone:508-755-5016
Mailing Address - Fax:508-753-2514
Practice Address - Street 1:210 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2204
Practice Address - Country:US
Practice Address - Phone:508-755-5016
Practice Address - Fax:508-753-2514
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA56178OtherFALLON COMMUNITY HEALTH P
MA351460OtherHARVARD PILGRIM
MA1697340Medicaid
MA6772997OtherCIGNA
MAY36868OtherBCBS MASSACHUSETTS
MA1106995OtherAETNA HEALTH CARE
MA1697340Medicaid
MAY45522Medicare PIN