Provider Demographics
NPI:1427411610
Name:SUPRAI, SOPHIA (DC)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:
Last Name:SUPRAI
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 1:903 EMBARCADERO DR
Mailing Address - Street 2:STE 4
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4098
Mailing Address - Country:US
Mailing Address - Phone:916-933-9870
Mailing Address - Fax:916-933-3540
Practice Address - Street 1:903 EMBARCADERO DR
Practice Address - Street 2:STE 4
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4098
Practice Address - Country:US
Practice Address - Phone:916-933-9870
Practice Address - Fax:916-933-3540
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC33504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor