Provider Demographics
NPI:1548301377
Name:CAMBOURIS, NICHOLAS SIMEON (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:SIMEON
Last Name:CAMBOURIS
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 1:1930 PEARL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-6477
Mailing Address - Country:US
Mailing Address - Phone:330-220-2001
Mailing Address - Fax:330-220-2232
Practice Address - Street 1:1930 PEARL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-6477
Practice Address - Country:US
Practice Address - Phone:330-220-2001
Practice Address - Fax:330-220-2232
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7141540OtherAETNA
OH000000374322OtherANTHEM
OH000000374322OtherANTHEM
OH4148881Medicare ID - Type Unspecified