Healthcare Provider Details

I. General information

NPI: 1679642680
Provider Name (Legal Business Name): DAVID J. SIMMER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAVID J. FIELDS

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6502 REGENCY LN
EDEN PRAIRIE MN
55344-7841
US

IV. Provider business mailing address

6502 REGENCY LN
EDEN PRAIRIE MN
55344-7841
US

V. Phone/Fax

Practice location:
  • Phone: 952-200-6071
  • Fax:
Mailing address:
  • Phone: 952-200-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4839
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: