MEDICARE: CHARLES M POPA III D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2006	OH
2	111N00000X	Chiropractor	08002022A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063473940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES M POPA III D.C.

Provider Business Mailing Address
First Line	:	3328 PRINCETON ROAD
Second Line	:
City	:	FAIRFIELD TOWNSHIP
State	:	OH
Zip	:	45011-5390
Country	:	US
Telephone Number	:	513-887-9400
Fax Number	:	513-887-7512

Provider Business Practice Location Address
First Line	:	3328 PRINCETON ROAD
Second Line	:
City	:	FAIRFIELD TOWNSHIP
State	:	OH
Zip	:	45011-5390
Country	:	US
Telephone Number	:	513-887-9400
Fax Number	:	513-887-7512

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	04/16/2012

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