Healthcare Provider Details

I. General information

NPI: 1942707393
Provider Name (Legal Business Name): MICHAEL EMMANUEL SIMELE DC, CCSP, ICSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20015 SW PACIFIC HWY STE 302
SHERWOOD OR
97140-9316
US

IV. Provider business mailing address

18019 SW LOWER BOONES FERRY RD
PORTLAND OR
97224-7228
US

V. Phone/Fax

Practice location:
  • Phone: 503-625-0500
  • Fax:
Mailing address:
  • Phone: 503-597-8624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5908
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: