Organization
LOUIS DEMICCO DO INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CINDY LEE PRUZINSKY (CLAIMS PROCESSER)
(440) 354-5643
Entity
Organization
Contact information
Practice address
263 MENTOR AVE, PAINESVILLE, OH 44077-3105
(440) 354-5643
(440) 354-5645
Mailing address
263 MENTOR AVE, PAINESVILLE, OH 44077-3105
(440) 354-5643
(440) 354-5645
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
233
OH
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
34006748
OH
225100000X
Physical Therapist
012350
OH
Other
Enumeration date
02/24/2014
Last updated
05/14/2014
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