Healthcare Provider Details

I. General information

NPI: 1659919207
Provider Name (Legal Business Name): SIMPSON CHIROPRACTIC OC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 BRISTOL ST STE C105
COSTA MESA CA
92626-5944
US

IV. Provider business mailing address

5324 E SHOSHONE AVE
ORANGE CA
92867-3266
US

V. Phone/Fax

Practice location:
  • Phone: 714-557-9454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: TYLER SIMPSON
Title or Position: OWNER
Credential: DC
Phone: 760-505-6166