Provider Demographics
NPI:1043591217
Name:WASHINGTON, SIMONE (DC)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:WASHINGTON
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:PO BOX 5977
Mailing Address - Street 2:DEPT 203052
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-5977
Mailing Address - Country:US
Mailing Address - Phone:630-754-8788
Mailing Address - Fax:630-754-8792
Practice Address - Street 1:4030 N. CICERO
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1807
Practice Address - Country:US
Practice Address - Phone:773-557-7766
Practice Address - Fax:773-557-7767
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-011451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor