Provider Demographics
NPI:1982605705
Name:SIMON, LINDA (DC)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10245 E VIA LINDA
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5315
Mailing Address - Country:US
Mailing Address - Phone:480-860-6890
Mailing Address - Fax:480-860-8583
Practice Address - Street 1:10245 E VIA LINDA
Practice Address - Street 2:SUITE 112
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5315
Practice Address - Country:US
Practice Address - Phone:480-860-6890
Practice Address - Fax:480-860-8583
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0938480OtherBLUE CROSS BLUE SHIELD AZ
AZT42153Medicare UPIN
AZZWMBCP02Medicare ID - Type Unspecified