Healthcare Provider Details

I. General information

NPI: 1477059137
Provider Name (Legal Business Name): CHRISTIAN ALEXANDER SIMMONS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 E OAK ST
SCOTTSDALE AZ
85257-2111
US

IV. Provider business mailing address

8015 S 16TH ST
PHOENIX AZ
85042-6720
US

V. Phone/Fax

Practice location:
  • Phone: 480-941-5252
  • Fax:
Mailing address:
  • Phone: 314-910-8487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number8675
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: