Provider Demographics
NPI:1730387879
Name:SIM, LEANNE M (DC)
Entity type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:M
Last Name:SIM
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 1:1819 S KIHEI RD STE B113
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7940
Mailing Address - Country:US
Mailing Address - Phone:808-874-0022
Mailing Address - Fax:
Practice Address - Street 1:1819 S KIHEI RD STE B113
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7940
Practice Address - Country:US
Practice Address - Phone:808-874-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor