Basic Information
| Provider Information | |||||||||
| NPI: | 1659401289 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | DABALOS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 S 18TH AVE | ||||||||
| Address2: | |||||||||
| City: | OTHELLO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993441580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094881558 | ||||||||
| FaxNumber: | 5094883347 | ||||||||
| Practice Location | |||||||||
| Address1: | 361 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OTHELLO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993441055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094883346 | ||||||||
| FaxNumber: | 5094883347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 11/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CH00003650 | WA | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 1154599454 | 01 | WA | GROUP NPI | OTHER |