MEDICARE: ILYA SIMAKOVSKY 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	111N00000X	Chiropractor	X004058-1	NY

General Provider Information

NPI Number	:	1578622486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILYA SIMAKOVSKY DC

Provider Business Mailing Address
First Line	:	34 W 12TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-8636
Country	:	US
Telephone Number	:	212-989-0850
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 W 12TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-8636
Country	:	US
Telephone Number	:	212-989-0850
Fax Number	:

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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Directions to “ ILYA SIMAKOVSKY DC” Practice Location

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