MEDICARE: DR. EDWARD M SIMON DDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC14240	CA

General Provider Information

NPI Number	:	1215968904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD M SIMON DDC

Provider Business Mailing Address
First Line	:	6344 LAUREL CANYON BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3213
Country	:	US
Telephone Number	:	818-761-1355
Fax Number	:	818-761-8705

Provider Business Practice Location Address
First Line	:	6344 LAUREL CANYON BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3213
Country	:	US
Telephone Number	:	818-761-1355
Fax Number	:	818-761-8705

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/08/2007

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