MEDICARE: DR. ROBERT W 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	1897	SC

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

General Provider Information

NPI Number	:	1578563508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT W SIMON D.C.

Provider Business Mailing Address
First Line	:	2421 HIGHWAY 17 SOUTH
Second Line	:
City	:	N MYRTLE BEACH
State	:	SC
Zip	:	29582-4343
Country	:	US
Telephone Number	:	843-272-7979
Fax Number	:	843-272-3534

Provider Business Practice Location Address
First Line	:	2421 HIGHWAY 17 SOUTH
Second Line	:
City	:	N MYRTLE BEACH
State	:	SC
Zip	:	29582-4343
Country	:	US
Telephone Number	:	843-272-7979
Fax Number	:	843-272-3534

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

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	07/08/2007

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