Provider Demographics
NPI:1063767697
Name:SOPCHAK CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:SOPCHAK CHIROPRACTIC CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOPCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-352-0444
Mailing Address - Street 1:7555 FREDLE DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9416
Mailing Address - Country:US
Mailing Address - Phone:440-352-0444
Mailing Address - Fax:440-352-0456
Practice Address - Street 1:7555 FREDLE DR
Practice Address - Street 2:SUITE 230
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9416
Practice Address - Country:US
Practice Address - Phone:440-352-0444
Practice Address - Fax:440-352-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSO0734621Medicare PIN
U40461Medicare UPIN