Provider Demographics
NPI:1861581910
Name:SIMOKOVICH, VINCENT M (DC)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:M
Last Name:SIMOKOVICH
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 1:12481 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-3414
Mailing Address - Country:US
Mailing Address - Phone:440-668-3747
Mailing Address - Fax:440-878-8702
Practice Address - Street 1:12481 PEARL RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-3414
Practice Address - Country:US
Practice Address - Phone:440-668-3747
Practice Address - Fax:440-878-8702
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH139712Medicare UPIN
OH4607068Medicare UPIN
OH139712Medicare UPIN