Healthcare Provider Details

I. General information

NPI: 1154560274
Provider Name (Legal Business Name): KYLIE BROOK SIMNIONIW D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S CENTRAL AVE
BEACH ND
58621-4001
US

IV. Provider business mailing address

110 S CENTRAL AVE PO BOX 908
BEACH ND
58621-4001
US

V. Phone/Fax

Practice location:
  • Phone: 701-872-7520
  • Fax: 701-872-7521
Mailing address:
  • Phone: 701-872-7520
  • Fax: 701-872-7521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number835
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: