Provider Demographics
NPI:1215201165
Name:MOHUCHY, SOPHIA LARISA (DC)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:LARISA
Last Name:MOHUCHY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 LINDEN BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4004
Mailing Address - Country:US
Mailing Address - Phone:516-285-7605
Mailing Address - Fax:516-285-7609
Practice Address - Street 1:1975 LINDEN BLVD STE 207
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4004
Practice Address - Country:US
Practice Address - Phone:516-285-7605
Practice Address - Fax:516-285-7609
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor