Provider Demographics
NPI:1457586695
Name:SIM, TOM H (DC, QME)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:H
Last Name:SIM
Suffix:
Gender:M
Credentials:DC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 HALFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-3205
Mailing Address - Country:US
Mailing Address - Phone:408-260-7575
Mailing Address - Fax:408-556-6773
Practice Address - Street 1:1470 HALFORD AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-3205
Practice Address - Country:US
Practice Address - Phone:408-260-7575
Practice Address - Fax:408-556-6773
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26928111NS0005X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0800XChiropractic ProvidersChiropractorOrthopedic