Provider Demographics
NPI:1013271089
Name:SIMPSON, ERICA ROSHELL (DC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ROSHELL
Last Name:SIMPSON
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 1:1412 SW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-5412
Mailing Address - Country:US
Mailing Address - Phone:816-694-7623
Mailing Address - Fax:
Practice Address - Street 1:506 SE 291 HWY
Practice Address - Street 2:UNIT I
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4388
Practice Address - Country:US
Practice Address - Phone:816-694-7623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011041270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor