Provider Demographics
NPI:1932389095
Name:SIMS, SCOTT A (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:SIMS
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 1:3801 NORTH ST
Mailing Address - Street 2:STE 18
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2473
Mailing Address - Country:US
Mailing Address - Phone:936-560-2405
Mailing Address - Fax:936-564-3401
Practice Address - Street 1:3801 NORTH ST
Practice Address - Street 2:STE 18
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2473
Practice Address - Country:US
Practice Address - Phone:936-560-2405
Practice Address - Fax:936-564-3401
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A6964Medicare PIN
TXU75259Medicare UPIN