Provider Demographics
NPI:1538341920
Name:SIMONSON, KRISTINE B (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:B
Last Name:SIMONSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N 132ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4000
Mailing Address - Country:US
Mailing Address - Phone:402-496-6090
Mailing Address - Fax:402-496-6158
Practice Address - Street 1:701 N 132ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4000
Practice Address - Country:US
Practice Address - Phone:402-496-6090
Practice Address - Fax:402-496-6158
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47081680700Medicaid
271414OtherMEDICARE PROVIDER NUMBER
271414OtherMEDICARE PROVIDER NUMBER