MEDICARE: DR. JULIE KOUTSOULIAS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3744	OH

General Provider Information

NPI Number	:	1780871210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JULIE KOUTSOULIAS, INC.

Provider Business Mailing Address
First Line	:	203 E ROYALTON RD STE 108
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-4038
Country	:	US
Telephone Number	:	440-886-6500
Fax Number	:	440-526-4119

Provider Business Practice Location Address
First Line	:	203 E ROYALTON RD STE 108
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-4038
Country	:	US
Telephone Number	:	440-886-6500
Fax Number	:	440-526-4119

Authorized Official
Title or Position	:	CHIROPRATOR OWNER
Name	:	JULIE K MONTEMARANO
Credential	:
Telephone Number	:	440-886-6500

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	05/22/2023

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