Provider Demographics
NPI:1235325267
Name:LANCASTER CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:LANCASTER CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERROLD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-653-2973
Mailing Address - Street 1:616 N COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-2535
Mailing Address - Country:US
Mailing Address - Phone:740-653-2973
Mailing Address - Fax:740-653-3249
Practice Address - Street 1:616 N COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-2535
Practice Address - Country:US
Practice Address - Phone:740-653-2973
Practice Address - Fax:740-653-3249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1066111N00000X, 111NN1001X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0582758Medicaid
OH6529360001Medicare NSC
OH0582758Medicaid