# LOUIS DEMICCO DO INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174948418
- **Authorized official:** MRS. CINDY LEE PRUZINSKY (CLAIMS PROCESSER)
- **Authorized official phone:** (440) 354-5643

## Contact information

- **Practice address:** 263 MENTOR AVE, PAINESVILLE, OH 44077-3105
- **Practice address phone:** (440) 354-5643
- **Practice address fax:** (440) 354-5645
- **Mailing address:** 263 MENTOR AVE, PAINESVILLE, OH 44077-3105
- **Mailing address phone:** (440) 354-5643
- **Mailing address fax:** (440) 354-5645

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 233 | OH | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 34006748 | OH | Yes |
| 225100000X | Physical Therapist | 012350 | OH | — |

## Other

- **Enumeration date:** 02/24/2014
- **Last updated:** 05/14/2014