Provider Demographics
NPI:1891817490
Name:SIMONSON, ROBERT A (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:SIMONSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8146 GREENBACK LN STE 108
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-2539
Mailing Address - Country:US
Mailing Address - Phone:916-723-3088
Mailing Address - Fax:916-726-1507
Practice Address - Street 1:8146 GREENBACK LN STE 108
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2539
Practice Address - Country:US
Practice Address - Phone:916-723-3088
Practice Address - Fax:916-726-1507
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor