Healthcare Provider Details

I. General information

NPI: 1275933608
Provider Name (Legal Business Name): ANDREW JOSEPH HOSPODAR IV D.C., M.S., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 BOARDMAN CANFIELD RD
BOARDMAN OH
44512
US

IV. Provider business mailing address

1265 BOARDMAN CANFIELD RD
BOARDMAN OH
44512-4004
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-9400
  • Fax: 330-726-8676
Mailing address:
  • Phone: 330-758-9400
  • Fax: 330-726-8676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC4453
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC4453
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number65.000287
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberACUP153
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: