Provider Demographics
NPI:1942279757
Name:SIMMONS, J. TERRY (D C)
Entity Type:Individual
Prefix:DR
First Name:J. TERRY
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23253 INTERSTATE 30
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-2571
Mailing Address - Country:US
Mailing Address - Phone:501-847-7246
Mailing Address - Fax:501-653-7248
Practice Address - Street 1:23253 INTERSTATE 30
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2571
Practice Address - Country:US
Practice Address - Phone:501-847-7246
Practice Address - Fax:501-653-7248
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR794111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART20714Medicare UPIN
AR5U965Medicare ID - Type Unspecified