Provider Demographics
NPI:1922328988
Name:SIMMONS, JAKE (DC)
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:SIMMONS
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 1:66-590 KAMEHAMEHA HWY STE 1B
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-1484
Mailing Address - Country:US
Mailing Address - Phone:808-291-2542
Mailing Address - Fax:808-491-0999
Practice Address - Street 1:66-590 KAMEHAMEHA HWY STE 1B
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1484
Practice Address - Country:US
Practice Address - Phone:808-291-2542
Practice Address - Fax:808-491-0999
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-1199111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor