Provider Demographics
NPI:1275267296
Name:CADWALLADER, SOPHIA EMILY (DC)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:EMILY
Last Name:CADWALLADER
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 1:7096 MARTINSON RD
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-9446
Mailing Address - Country:US
Mailing Address - Phone:608-630-3561
Mailing Address - Fax:
Practice Address - Street 1:1777 W MAIN ST STE 107
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-3100
Practice Address - Country:US
Practice Address - Phone:608-318-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6006-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor