Provider Demographics
NPI:1811078413
Name:SIMONS, CHRISTOPHER JOHN (CHRISTOPHER SIMONS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:SIMONS
Suffix:
Gender:M
Credentials:CHRISTOPHER SIMONS
Other - Prefix:DR
Other - First Name:CHRISTOPHER
Other - Middle Name:JOHN
Other - Last Name:SIMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CHRISTOPHER SIMONS
Mailing Address - Street 1:3009 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241-1926
Mailing Address - Country:US
Mailing Address - Phone:192-079-3449
Mailing Address - Fax:
Practice Address - Street 1:3009 FOREST AVE
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-1926
Practice Address - Country:US
Practice Address - Phone:192-079-3449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor