Provider Demographics
NPI:1710110614
Name:ANTHONY SIMONE
Entity Type:Organization
Organization Name:ANTHONY SIMONE
Other - Org Name:NORTHLAND IDD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-415-9999
Mailing Address - Street 1:1201 LANDMARK AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1050
Mailing Address - Country:US
Mailing Address - Phone:816-415-9999
Mailing Address - Fax:816-792-1201
Practice Address - Street 1:1201 LANDMARK AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1050
Practice Address - Country:US
Practice Address - Phone:816-415-9999
Practice Address - Fax:816-415-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty