MEDICARE: DR. JONATHAN DAVID SIMON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH 1586	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	814646	OTHER	MD	USHEALTHCARE ID
2	4400207	OTHER	MD	UNITEDHEALTHCARE ID
3	351074	OTHER	MA	HARVARDPILGRIM ID
4	4615159	OTHER	MA	AETNA ID
5	SIY36128	OTHER	MA	BLUECROSSBLUESHIELD ID

General Provider Information

NPI Number	:	1134266349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN DAVID SIMON D.C.

Provider Business Mailing Address
First Line	:	1815 MASSACHUSETTS AVE # 007
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02140-1430
Country	:	US
Telephone Number	:	617-497-9474
Fax Number	:	617-868-4357

Provider Business Practice Location Address
First Line	:	1815 MASSACHUSETTS AVE # 007
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02140-1430
Country	:	US
Telephone Number	:	617-497-9474
Fax Number	:	617-868-4357

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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