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NPI Code Detail

MEDICARE: SIMON R. GO CHIROPRACTIC INC.

MEDICARE: SIMON R. GO CHIROPRACTIC INC.
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
1111N00000XChiropractorDC20602CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
120602OTHERCALICENSE NUMBER

General Provider Information

NPI Number : 1952462525
Entity Type Code : Organization
Provider Name (Legal Business Name) : SIMON R. GO CHIROPRACTIC INC.
Provider Business Mailing Address
First Line : 14623 HAWTHORNE BLVD
Second Line : SUITE206
City : LAWNDALE
State : CA
Zip : 90260-1581
Country : US
Telephone Number : 310-675-8803
Fax Number : 310-370-7380
Provider Business Practice Location Address
First Line : 14623 HAWTHORNE BLVD
Second Line : SUITE206
City : LAWNDALE
State : CA
Zip : 90260-1581
Country : US
Telephone Number : 310-675-8803
Fax Number : 310-370-7380
Authorized Official
Title or Position : CEO
Name : DR. SIMON REYES GO
Credential : D.C.
Telephone Number : 310-675-8803
Provider Enumeration Date : 12/13/2006
Last Update Date : 08/22/2020

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Directions to “SIMON R. GO CHIROPRACTIC INC. ” Practice Location

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