Provider Demographics
NPI:1881878858
Name:SIMOSON CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:SIMOSON CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:SIMOSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-934-2131
Mailing Address - Street 1:37315 HARVEST DRIVE
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2168925Medicaid
OH4014231Medicare PIN
OHU74884Medicare UPIN