Provider Demographics
NPI:1073405551
Name:SHIM, ETHAN BENJAMIN (DC)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:BENJAMIN
Last Name:SHIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W ROYALTON RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3946
Mailing Address - Country:US
Mailing Address - Phone:440-230-1113
Mailing Address - Fax:
Practice Address - Street 1:1100 W ROYALTON RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-3946
Practice Address - Country:US
Practice Address - Phone:440-230-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor