Provider Demographics
NPI:1114995412
Name:SOPER, PATRICIA R (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:R
Last Name:SOPER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:R
Other - Last Name:SOPER-OAKES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:303 SENECA RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843
Mailing Address - Country:US
Mailing Address - Phone:607-324-1127
Mailing Address - Fax:607-324-0729
Practice Address - Street 1:303 SENECA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843
Practice Address - Country:US
Practice Address - Phone:607-324-1127
Practice Address - Fax:607-324-0729
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB2371Medicare PIN
NYU72368Medicare UPIN