Healthcare Provider Details

I. General information

NPI: 1902109739
Provider Name (Legal Business Name): SIMMONS CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 S 72ND ST STE 102
TACOMA WA
98408-1297
US

IV. Provider business mailing address

1720 S 72ND ST STE 102
TACOMA WA
98408-1297
US

V. Phone/Fax

Practice location:
  • Phone: 253-472-4424
  • Fax: 253-471-9806
Mailing address:
  • Phone: 253-472-4424
  • Fax: 253-471-9806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00000751
License Number StateWA

VIII. Authorized Official

Name: DR. DEAN SIMMONS
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 253-472-4424