MEDICARE: DR. CHRISTOPHER JOHN SIMONS CHRISTOPHER SIMONS

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	3351	WI

General Provider Information

NPI Number	:	1811078413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER JOHN SIMONS CHRISTOPHER SIMONS

Provider Business Mailing Address
First Line	:	3009 FOREST AVE
Second Line	:
City	:	TWO RIVERS
State	:	WI
Zip	:	54241-1926
Country	:	US
Telephone Number	:	192-079-3449
Fax Number	:

Provider Business Practice Location Address
First Line	:	3009 FOREST AVE
Second Line	:
City	:	TWO RIVERS
State	:	WI
Zip	:	54241-1926
Country	:	US
Telephone Number	:	192-079-3449
Fax Number	:

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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