=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437392610
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POPP FAMILY CHIROPRACTIC P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2009
-----------------------------------------------------
Last Update Date | 06/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1938 RIDGE RD
-----------------------------------------------------
City | HOMEWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60430-1730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-922-1883
-----------------------------------------------------
Fax | 866-204-3818
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1938 RIDGE RD
-----------------------------------------------------
City | HOMEWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60430-1730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-922-1883
-----------------------------------------------------
Fax | 866-204-8818
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER/SPOUSE
-----------------------------------------------------
Name | MRS. RITA MARIA POPP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-922-1883
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038-007440
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------