Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4184 | OH |
N | 111NI0013X | Independent Medical Examiner | 4184 | OH |
NPI | 1740576594 |
---|---|
Provider Name | Timothy William Sopp |
First Address | Columbus, OH 43235-8939 |
Second Address | Columbus, OH 43240-4067 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2011 |
Last Update Date | 21/06/2011 |