MEDICARE: DR. MICHAEL P SIMONE DC

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	111NS0005X	Sports Physician Chiropractor	4506	CO

General Provider Information

NPI Number	:	1194727313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL P SIMONE DC

Provider Business Mailing Address
First Line	:	1111 1ST ST
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-1702
Country	:	US
Telephone Number	:	303-833-2332
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 1ST ST
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-1702
Country	:	US
Telephone Number	:	303-833-2332
Fax Number	:

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/02/2015

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Directions to “ DR. MICHAEL P SIMONE DC” Practice Location

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