Healthcare Provider Details

I. General information

NPI: 1063473940
Provider Name (Legal Business Name): CHARLES M POPA III D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3328 PRINCETON ROAD
FAIRFIELD TOWNSHIP OH
45011-5390
US

IV. Provider business mailing address

3328 PRINCETON ROAD
FAIRFIELD TOWNSHIP OH
45011-5390
US

V. Phone/Fax

Practice location:
  • Phone: 513-887-9400
  • Fax: 513-887-7512
Mailing address:
  • Phone: 513-887-9400
  • Fax: 513-887-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2006
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002022A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: