Provider Demographics
NPI:1891860219
Name:SIMARD, ANNETTE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:MARIE
Last Name:SIMARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 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
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR119613Medicare ID - Type UnspecifiedPHYSICIAN NUMBER