Provider Demographics
NPI:1396490595
Name:SIMPSON, TATIANA CASTILLO (DC)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:CASTILLO
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 1:4309 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6819
Mailing Address - Country:US
Mailing Address - Phone:260-436-3783
Mailing Address - Fax:260-432-2330
Practice Address - Street 1:4309 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6819
Practice Address - Country:US
Practice Address - Phone:260-436-3783
Practice Address - Fax:260-432-2330
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003254A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor