Healthcare Provider Details

I. General information

NPI: 1942279757
Provider Name (Legal Business Name): J. TERRY SIMMONS D. C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23253 INTERSTATE 30
BRYANT AR
72022-2571
US

IV. Provider business mailing address

23253 INTERSTATE 30
BRYANT AR
72022-2571
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-7246
  • Fax: 501-653-7248
Mailing address:
  • Phone: 501-847-7246
  • Fax: 501-653-7248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number794
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number794
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: