Provider Demographics
NPI:1821107400
Name:SIMOSON, LEO HERBERT (DC)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:HERBERT
Last Name:SIMOSON
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 1:37315 HARVEST AVE
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2803
Mailing Address - Country:US
Mailing Address - Phone:440-934-2131
Mailing Address - Fax:440-934-2132
Practice Address - Street 1:37315 HARVEST AVE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2803
Practice Address - Country:US
Practice Address - Phone:440-934-2131
Practice Address - Fax:440-934-2132
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC. 2778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2168925Medicaid
OH4014231Medicare PIN
OHU74884Medicare UPIN