Provider Demographics
NPI:1154408201
Name:PROKOPIAK, JOHN ALEXANDER (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEXANDER
Last Name:PROKOPIAK
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 1:4816 WOOD POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3526
Mailing Address - Country:US
Mailing Address - Phone:941-923-0907
Mailing Address - Fax:941-923-4187
Practice Address - Street 1:4370 S TAMIAMI TRL STE 235
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3414
Practice Address - Country:US
Practice Address - Phone:941-923-0907
Practice Address - Fax:941-923-4187
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1425OtherLICENSE NUMBER
AZ5491OtherLICENSE NUMBER
FLCH7143OtherLICENSE NUMBER
FLCH7143OtherLICENSE NUMBER