Provider Demographics
NPI:1811028517
Name:SIMARD CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:SIMARD CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-942-9031
Mailing Address - Street 1:1011 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-2231
Mailing Address - Country:US
Mailing Address - Phone:541-942-9031
Mailing Address - Fax:541-942-9031
Practice Address - Street 1:1011 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-2231
Practice Address - Country:US
Practice Address - Phone:541-942-9031
Practice Address - Fax:541-942-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR119611Medicare ID - Type Unspecified