Provider Demographics
NPI:1144630377
Name:SIMMONS, DAVID (LAC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:480 OSBORNE RD NE STE MR 48200
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2773
Practice Address - Country:US
Practice Address - Phone:763-236-5656
Practice Address - Fax:763-236-5635
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1626171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist