Provider Demographics
NPI:1740409002
Name:SIMKOVICH, CHARLES A (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:SIMKOVICH
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 1:52 PINE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9366
Mailing Address - Country:US
Mailing Address - Phone:412-366-3700
Mailing Address - Fax:412-369-9139
Practice Address - Street 1:52 PINE CREEK RD
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9366
Practice Address - Country:US
Practice Address - Phone:412-366-3700
Practice Address - Fax:412-369-9139
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002884L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor