Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC26928 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | DC26928 | CA |
NPI | 1457586695 |
---|---|
Provider Name | Tom H. Sim |
First Address | Santa Clara, CA 95051-3205 |
Second Address | Santa Clara, CA 95051-3205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2009 |
Last Update Date | 18/05/2009 |