Healthcare Provider Details

I. General information

NPI: 1659041309
Provider Name (Legal Business Name): BRANDY SIMMONS D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18484 PRESTON RD STE 202
DALLAS TX
75252-5475
US

IV. Provider business mailing address

1350 N GREENVILLE AVE APT 4413
RICHARDSON TX
75081-2980
US

V. Phone/Fax

Practice location:
  • Phone: 469-534-9745
  • Fax:
Mailing address:
  • Phone: 469-534-9745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number14887
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number14887
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: