Provider Demographics
NPI:1174606883
Name:SIMMS, LAURISSA CS (DC)
Entity type:Individual
Prefix:MRS
First Name:LAURISSA
Middle Name:CS
Last Name:SIMMS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:82 WEATHERVANE DR
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-5956
Mailing Address - Country:US
Mailing Address - Phone:978-660-5334
Mailing Address - Fax:
Practice Address - Street 1:54 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3276
Practice Address - Country:US
Practice Address - Phone:978-537-0555
Practice Address - Fax:978-537-2193
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000767Medicare UPIN