Provider Demographics
NPI:1821349069
Name:SIMON CHIROPRACTIC INSTITUTE, LLC
Entity Type:Organization
Organization Name:SIMON CHIROPRACTIC INSTITUTE, LLC
Other - Org Name:SIMONE SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-886-4071
Mailing Address - Street 1:14019 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3563
Mailing Address - Country:US
Mailing Address - Phone:832-886-4054
Mailing Address - Fax:
Practice Address - Street 1:14019 SOUTHWEST FWY
Practice Address - Street 2:SUITE 310
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3563
Practice Address - Country:US
Practice Address - Phone:832-886-4054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty