Provider Demographics
NPI:1891427456
Name:SIMONTON, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:SIMONTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3368 STATE ROUTE 752
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43103-9009
Mailing Address - Country:US
Mailing Address - Phone:406-989-0475
Mailing Address - Fax:
Practice Address - Street 1:3368 STATE ROUTE 752
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:OH
Practice Address - Zip Code:43103-9009
Practice Address - Country:US
Practice Address - Phone:740-983-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor