Provider Demographics
NPI:1275574964
Name:SOLOMON, JERROLD LEWIS (DC)
Entity Type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:LEWIS
Last Name:SOLOMON
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 1:716 W MARKET ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2582
Mailing Address - Country:US
Mailing Address - Phone:419-443-8877
Mailing Address - Fax:419-443-8885
Practice Address - Street 1:716 W MARKET ST
Practice Address - Street 2:SUITE A
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2582
Practice Address - Country:US
Practice Address - Phone:419-443-8877
Practice Address - Fax:419-443-8885
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0921195Medicaid
OH9331011Medicare ID - Type Unspecified