Healthcare Provider Details

I. General information

NPI: 1073803698
Provider Name (Legal Business Name): JOSE ADOLFO SIMON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14019 SW. FRWY SUITE 310
SUGARLAND TX
77478
US

IV. Provider business mailing address

14019 SW. FRWY. SUITE 310
SUGARLAND TX
77478
US

V. Phone/Fax

Practice location:
  • Phone: 832-886-4054
  • Fax: 832-886-4071
Mailing address:
  • Phone: 832-886-4054
  • Fax: 832-886-4071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11715
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: