Provider Demographics
NPI:1356486468
Name:STOW-KENT CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:STOW-KENT CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR
Authorized Official - Phone:330-686-1333
Mailing Address - Street 1:2991 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-3619
Mailing Address - Country:US
Mailing Address - Phone:330-686-1333
Mailing Address - Fax:330-686-9275
Practice Address - Street 1:2991 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-3619
Practice Address - Country:US
Practice Address - Phone:330-686-1333
Practice Address - Fax:330-686-9275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0987615Medicaid
OH0987615Medicaid