Provider Demographics
NPI:1790968378
Name:FAMILY CHIROPRACTIC SIMONE & VINING
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC SIMONE & VINING
Other - Org Name:FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-643-2616
Mailing Address - Street 1:613 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-1721
Mailing Address - Country:US
Mailing Address - Phone:814-643-2616
Mailing Address - Fax:814-643-6115
Practice Address - Street 1:613 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1721
Practice Address - Country:US
Practice Address - Phone:814-643-2616
Practice Address - Fax:814-643-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006522L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1164470464OtherHIGHMARK
PA1063461952OtherHIGHMARK