Provider Demographics
NPI:1922043298
Name:SIMIONIDES, NICK PETER (DC,CCSP)
Entity Type:Individual
Prefix:MR
First Name:NICK
Middle Name:PETER
Last Name:SIMIONIDES
Suffix:
Gender:M
Credentials:DC,CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-3530
Mailing Address - Country:US
Mailing Address - Phone:330-821-1777
Mailing Address - Fax:330-821-4243
Practice Address - Street 1:2301 W STATE ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-3530
Practice Address - Country:US
Practice Address - Phone:330-821-1777
Practice Address - Fax:330-821-4243
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1170111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT48495Medicare UPIN