Healthcare Provider Details

I. General information

NPI: 1699863696
Provider Name (Legal Business Name): SIMON M BILLINGHAM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9316 E RAINTREE DR STE 140
SCOTTSDALE AZ
85260-3005
US

IV. Provider business mailing address

9316 E RAINTREE DR STE 140
SCOTTSDALE AZ
85260-3005
US

V. Phone/Fax

Practice location:
  • Phone: 480-614-2322
  • Fax: 480-614-2522
Mailing address:
  • Phone: 480-614-2322
  • Fax: 480-614-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number6058
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: