MEDICARE: DR. SIMON PAUL CALVILLO 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	2198	NC
2	111N00000X	Chiropractor	4234	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0829F	OTHER	NC	BLUE CROSS BLUE SHIELD
3	262694	OTHER	NC	MAMSI
4	14163723	OTHER	NC	WASAU

General Provider Information

NPI Number	:	1437265477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIMON PAUL CALVILLO D.C

Provider Business Mailing Address
First Line	:	1322 W MAIN ST
Second Line	:
City	:	FOREST CITY
State	:	NC
Zip	:	28043-2555
Country	:	US
Telephone Number	:	828-289-6828
Fax Number	:

Provider Business Practice Location Address
First Line	:	1322 W MAIN ST
Second Line	:
City	:	FOREST CITY
State	:	NC
Zip	:	28043-2555
Country	:	US
Telephone Number	:	828-245-4002
Fax Number	:	828-245-4025

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	04/28/2017

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