Provider Demographics
NPI:1942213244
Name:SIMON CHIROPRACTIC
Entity Type:Organization
Organization Name:SIMON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-272-7979
Mailing Address - Street 1:2421 HIGHWAY 17 S
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-4343
Mailing Address - Country:US
Mailing Address - Phone:843-272-7979
Mailing Address - Fax:843-272-3534
Practice Address - Street 1:2421 HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-4343
Practice Address - Country:US
Practice Address - Phone:843-272-7979
Practice Address - Fax:843-272-3534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty