MEDICARE: DR. NICHOLAS SIMEON CAMBOURIS D.C.

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	3400	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7141540	OTHER	OH	AETNA
2	000000374322	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1548301377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS SIMEON CAMBOURIS D.C.

Provider Business Mailing Address
First Line	:	1930 PEARL RD
Second Line	:	SUITE 2
City	:	BRUNSWICK
State	:	OH
Zip	:	44212-6477
Country	:	US
Telephone Number	:	330-220-2001
Fax Number	:	330-220-2232

Provider Business Practice Location Address
First Line	:	1930 PEARL RD
Second Line	:	SUITE 2
City	:	BRUNSWICK
State	:	OH
Zip	:	44212-6477
Country	:	US
Telephone Number	:	330-220-2001
Fax Number	:	330-220-2232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	01/26/2016

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Directions to “ DR. NICHOLAS SIMEON CAMBOURIS D.C.” Practice Location

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