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General NPI Number Information
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NPI Number | 1275933608
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Entity Type | Individual
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Provider Name | ANDREW JOSEPH HOSPODAR IV D.C., M.S., L.AC.
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Gender | Male
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Dates
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Enumeration Date | 09/04/2014
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 1265 BOARDMAN CANFIELD RD
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City | BOARDMAN
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State | OH
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Zip | 44512
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Country | US
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Telephone | 330-758-9400
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Fax | 330-726-8676
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Provider Business Mailing Address
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Address Line | 1265 BOARDMAN CANFIELD RD
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City | BOARDMAN
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State | OH
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Zip | 44512-4004
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Country | US
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Telephone | 330-758-9400
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Fax | 330-726-8676
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | DC4453
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC4453
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 65.000287
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | ACUP153
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License Number State | OH
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