Provider Demographics
NPI:1881702926
Name:SIMON, ANDREW CHRISTOPHER (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:CHRISTOPHER
Last Name:SIMON
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 1:2500 S POWER RD
Mailing Address - Street 2:STE 106
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-6686
Mailing Address - Country:US
Mailing Address - Phone:480-962-6011
Mailing Address - Fax:480-924-4709
Practice Address - Street 1:2500 S POWER RD
Practice Address - Street 2:STE 106
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6686
Practice Address - Country:US
Practice Address - Phone:480-962-6011
Practice Address - Fax:480-924-4709
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ108535Medicare PIN
AZV08559Medicare UPIN