Healthcare Provider Details

I. General information

NPI: 1427411610
Provider Name (Legal Business Name): SOPHIA SUPRAI D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6049 DOUGLAS BLVD STE 4
GRANITE BAY CA
95746-6249
US

IV. Provider business mailing address

6049 DOUGLAS BLVD STE 4
GRANITE BAY CA
95746-6249
US

V. Phone/Fax

Practice location:
  • Phone: 916-872-1999
  • Fax: 916-872-1919
Mailing address:
  • Phone: 916-872-1999
  • Fax: 916-872-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC33504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: