=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457140725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NERVE NATUROPATHY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2025
-----------------------------------------------------
Last Update Date | 05/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6009 CAPITOL BLVD SW STE 103C
-----------------------------------------------------
City | TUMWATER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98501-5295
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-338-3735
-----------------------------------------------------
Fax | 360-338-3742
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 HIGHWAY 603
-----------------------------------------------------
City | CHEHALIS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98532-9064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-507-6208
-----------------------------------------------------
Fax | 360-338-3742
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PHYSICIAN
-----------------------------------------------------
Name | DR. DEREK SIMPSON
-----------------------------------------------------
Credential | DC, ND
-----------------------------------------------------
Telephone | 815-507-6208
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------