Healthcare Provider Details

I. General information

NPI: 1740576594
Provider Name (Legal Business Name): TIMOTHY WILLIAM SOPP D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9039 ANTARES AVE
COLUMBUS OH
43240-4067
US

IV. Provider business mailing address

145 RADIO CITY BLVD
COLUMBUS OH
43235-8939
US

V. Phone/Fax

Practice location:
  • Phone: 614-888-7900
  • Fax: 614-888-7970
Mailing address:
  • Phone: 614-888-7900
  • Fax: 614-888-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4184
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number4184
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: