MEDICARE: LEO HERBERT SIMOSON DC

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	DC. 2778	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821107400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEO HERBERT SIMOSON DC

Provider Business Mailing Address
First Line	:	37315 HARVEST AVE
Second Line	:
City	:	AVON
State	:	OH
Zip	:	44011-2803
Country	:	US
Telephone Number	:	440-934-2131
Fax Number	:	440-934-2132

Provider Business Practice Location Address
First Line	:	37315 HARVEST AVE
Second Line	:
City	:	AVON
State	:	OH
Zip	:	44011-2803
Country	:	US
Telephone Number	:	440-934-2131
Fax Number	:	440-934-2132

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	05/08/2008

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Directions to “ LEO HERBERT SIMOSON DC” Practice Location

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