Provider Demographics
NPI:1457697476
Name:MITCHELL D SIMON PC
Entity Type:Organization
Organization Name:MITCHELL D SIMON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-206-3250
Mailing Address - Street 1:697 CAMBRIDGE ST
Mailing Address - Street 2:STE 303
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2897
Mailing Address - Country:US
Mailing Address - Phone:617-206-3250
Mailing Address - Fax:617-206-3252
Practice Address - Street 1:697 CAMBRIDGE ST
Practice Address - Street 2:SUITE 303
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2897
Practice Address - Country:US
Practice Address - Phone:617-206-3250
Practice Address - Fax:617-206-3252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT58258Medicare UPIN