Healthcare Provider Details

I. General information

NPI: 1063767697
Provider Name (Legal Business Name): SOPCHAK CHIROPRACTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7555 FREDLE DR SUITE 230
CONCORD TWP OH
44077-9416
US

IV. Provider business mailing address

7555 FREDLE DR SUITE 230
CONCORD TWP OH
44077-9416
US

V. Phone/Fax

Practice location:
  • Phone: 440-352-0444
  • Fax: 440-352-0456
Mailing address:
  • Phone: 440-352-0444
  • Fax: 440-352-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1823
License Number StateOH

VIII. Authorized Official

Name: DR. WILLIAM J SOPCHAK
Title or Position: OWNER
Credential: DC
Phone: 440-352-0444