Provider Demographics
NPI:1760649727
Name:SIMMONS, AUSTIN NICHOLAS I (DC)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:NICHOLAS
Last Name:SIMMONS
Suffix:I
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:51099 BITTERSWEET RD
Mailing Address - Street 2:STE H
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4990
Mailing Address - Country:US
Mailing Address - Phone:574-271-4628
Mailing Address - Fax:574-271-8247
Practice Address - Street 1:51099 BITTERSWEET RD
Practice Address - Street 2:STE H
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-4990
Practice Address - Country:US
Practice Address - Phone:574-271-4628
Practice Address - Fax:574-271-8247
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002355A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor