Provider Demographics
NPI:1336202985
Name:SIMPSON, JEFFREY L (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 E COLLEGE AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7542
Mailing Address - Country:US
Mailing Address - Phone:814-235-2266
Mailing Address - Fax:814-235-1715
Practice Address - Street 1:2603 E COLLEGE AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7542
Practice Address - Country:US
Practice Address - Phone:814-235-2266
Practice Address - Fax:814-235-1715
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002885L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009898840002Medicaid
PA0009898840002Medicaid