Provider Demographics
NPI:1265589659
Name:SIMMONS, PETER J (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:63 TREETOP CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07403-1016
Mailing Address - Country:US
Mailing Address - Phone:973-337-9560
Mailing Address - Fax:732-638-5447
Practice Address - Street 1:800 CONVERY BLVD
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-2584
Practice Address - Country:US
Practice Address - Phone:973-337-9560
Practice Address - Fax:732-638-5447
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMC04846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor