Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 1066 | OH |
Y | 111NR0400X | Rehabilitation Chiropractor | 1066 | OH |
NPI | 1548219892 |
---|---|
Provider Name | Dr. Jerrold J. Simon |
First Address | Lancaster, OH 43130-2535 |
Second Address | Lancaster, OH 43130-2535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2006 |
Last Update Date | 11/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0582758 | (05) | OH |
T48092 | (02) | OH |