Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | ACUP153 | OH |
N | 111N00000X | Chiropractor | DC4453 | OH |
Y | 111NS0005X | Chiropractic Sports Physician | DC4453 | OH |
NPI | 1275933608 |
---|---|
Provider Name | Dr. Andrew Joseph Hospodar IV |
First Address | Boardman, OH 44512-4004 |
Second Address | Boardman, OH 44512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2014 |
Last Update Date | 03/08/2021 |