Provider Demographics
NPI:1043369242
Name:DABNEY, SOPHIA E (DC)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:E
Last Name:DABNEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SOPHIA
Other - Middle Name:E
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:21 BERGMAN CT APT 7
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1258
Mailing Address - Country:US
Mailing Address - Phone:773-414-8836
Mailing Address - Fax:
Practice Address - Street 1:21 BERGMAN CT APT 7
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1258
Practice Address - Country:US
Practice Address - Phone:773-414-8836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK10261Medicare PIN