Healthcare Provider Details

I. General information

NPI: 1346317807
Provider Name (Legal Business Name): BENJAMIN AXEL SIMONSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S SPLITROCK BLVD STE 1
BRANDON SD
57005-1679
US

IV. Provider business mailing address

314 S SPLITROCK BLVD STE 1
BRANDON SD
57005-1679
US

V. Phone/Fax

Practice location:
  • Phone: 605-582-8825
  • Fax: 605-582-8827
Mailing address:
  • Phone: 605-582-8825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number1031
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: