=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750566311
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POPOVICS CHIROPRACTIC, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2008
-----------------------------------------------------
Last Update Date | 01/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 GARDEN VIEW RD SUITE 106
-----------------------------------------------------
City | ENCINITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92024-2477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-436-2073
-----------------------------------------------------
Fax | 760-436-6986
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 GARDEN VIEW RD SUITE 106
-----------------------------------------------------
City | ENCINITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92024-2477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-436-2073
-----------------------------------------------------
Fax | 760-436-6986
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. DAMON JOSEF POPOVICS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 760-436-2073
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC28525
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------