=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154408201
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN ALEXANDER PROKOPIAK D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4370 S TAMIAMI TRL STE 235
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34231-3414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-923-0907
-----------------------------------------------------
Fax | 941-923-4187
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4816 WOOD POINTE WAY
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34233-3526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-923-0907
-----------------------------------------------------
Fax | 941-923-4187
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH7143
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------