Provider Demographics
NPI:1235308172
Name:LIN, SOPHIA VIVIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:VIVIAN
Last Name:LIN
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 1:81 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8875
Mailing Address - Country:US
Mailing Address - Phone:631-680-7368
Mailing Address - Fax:631-928-8340
Practice Address - Street 1:379 OLD TOWN RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2245
Practice Address - Country:US
Practice Address - Phone:631-680-7368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011650-1111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition