Provider Demographics
NPI:1548219892
Name:SIMON, JERROLD J (DC)
Entity type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:J
Last Name:SIMON
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 1:616 N COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-2535
Mailing Address - Country:US
Mailing Address - Phone:740-653-2973
Mailing Address - Fax:740-653-3249
Practice Address - Street 1:616 N COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-2535
Practice Address - Country:US
Practice Address - Phone:740-653-2973
Practice Address - Fax:740-653-3249
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1066111NR0400X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0582758Medicaid
OH0582758Medicaid
OHSI0555453Medicare PIN