Provider Demographics
NPI:1316054729
Name:POPOWICH, JOHN M (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:POPOWICH
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 1:71 S. MAIN ST
Mailing Address - Street 2:#2
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470
Mailing Address - Country:US
Mailing Address - Phone:203-304-9037
Mailing Address - Fax:203-841-1051
Practice Address - Street 1:71 S. MAIN ST
Practice Address - Street 2:#2
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470
Practice Address - Country:US
Practice Address - Phone:203-304-9037
Practice Address - Fax:203-841-1051
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21780111N00000X, 111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NT0100XChiropractic ProvidersChiropractorThermography
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC021780Medicare UPIN
CADC0217800Medicare ID - Type Unspecified