Provider Demographics
NPI:1508843574
Name:SHIMMEL, MICHAEL A (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:SHIMMEL
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 1:2991 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
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0641425Medicaid
0591002Medicare ID - Type Unspecified
T48483Medicare UPIN