Provider Demographics
NPI:1588058762
Name:SIMMONS, TYLER D (DC)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:D
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CANARY LN
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1645
Mailing Address - Country:US
Mailing Address - Phone:859-744-7319
Mailing Address - Fax:859-744-7319
Practice Address - Street 1:29 CANARY LN
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391
Practice Address - Country:US
Practice Address - Phone:859-744-7319
Practice Address - Fax:859-744-7319
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5457111N00000X
KY249094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY861128239Medicaid