Provider Demographics
NPI:1457412074
Name:SIMPER, DOUG (DC)
Entity type:Individual
Prefix:DR
First Name:DOUG
Middle Name:
Last Name:SIMPER
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 1:218 LAGARTO CT
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:TX
Mailing Address - Zip Code:77362-4104
Mailing Address - Country:US
Mailing Address - Phone:630-709-5780
Mailing Address - Fax:
Practice Address - Street 1:218 LAGARTO CT
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:TX
Practice Address - Zip Code:77362-4104
Practice Address - Country:US
Practice Address - Phone:630-709-5780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008756111N00000X, 247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU80400Medicare UPIN
ILL78604Medicare PIN