MEDICARE: DAVID J. SIMMER 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	111NR0400X	Rehabilitation Chiropractor	4839	MN

General Provider Information

NPI Number	:	1679642680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID J. SIMMER D.C.

Provider Business Mailing Address
First Line	:	6502 REGENCY LN
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7841
Country	:	US
Telephone Number	:	952-200-6071
Fax Number	:

Provider Business Practice Location Address
First Line	:	6502 REGENCY LN
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7841
Country	:	US
Telephone Number	:	952-200-6071
Fax Number	:

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	08/14/2007

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