Provider Demographics
NPI:1205285111
Name:SIMONSEN CHIROPRACTIC, PC
Entity type:Organization
Organization Name:SIMONSEN CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-229-1863
Mailing Address - Street 1:200 5TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3116
Mailing Address - Country:US
Mailing Address - Phone:712-546-8152
Mailing Address - Fax:712-546-7653
Practice Address - Street 1:200 5TH AVE NW
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3116
Practice Address - Country:US
Practice Address - Phone:712-546-8152
Practice Address - Fax:712-546-7653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0118285Medicaid