Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 4506 | CO |
NPI | 1194727313 |
---|---|
Provider Name | Dr. Michael P Simone |
First Address | Fort Lupton, CO 80621-1702 |
Second Address | Fort Lupton, CO 80621-1702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 02/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T21624 | (02) | CO |