MEDICARE: DR. JONATHAN WILLIAM SIMMONS III D.C. FIAMA

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	4517	TX

General Provider Information

NPI Number	:	1598772303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN WILLIAM SIMMONS III D.C. FIAMA

Provider Business Mailing Address
First Line	:	7010 W HIGHWAY 71
Second Line	:	SUITE 360
City	:	AUSTIN
State	:	TX
Zip	:	78735-8300
Country	:	US
Telephone Number	:	512-288-5322
Fax Number	:	512-288-3680

Provider Business Practice Location Address
First Line	:	7010 W HIGHWAY 71
Second Line	:	SUITE 360
City	:	AUSTIN
State	:	TX
Zip	:	78735-8300
Country	:	US
Telephone Number	:	512-288-5322
Fax Number	:	512-288-3680

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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