MEDICARE: SIMON CHIROPRACTIC

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

General Provider Information

NPI Number	:	1942213244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMON CHIROPRACTIC

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

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT W SIMON
Credential	:	DC
Telephone Number	:	843-272-7979

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	08/22/2020

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Directions to “SIMON CHIROPRACTIC ” Practice Location

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