MEDICARE: DR. KANDI SIMON D.C.

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	6228	CO

General Provider Information

NPI Number	:	1679710917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KANDI SIMON D.C.

Provider Business Mailing Address
First Line	:	2227 N WEBER ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6946
Country	:	US
Telephone Number	:	719-433-0750
Fax Number	:

Provider Business Practice Location Address
First Line	:	2227 N WEBER ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6946
Country	:	US
Telephone Number	:	719-433-0750
Fax Number	:

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

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	01/08/2009

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