Provider Demographics
NPI:1508937764
Name:SOPLER, DIDRIK JOHANNES (PHD, LAC)
Entity Type:Individual
Prefix:DR
First Name:DIDRIK
Middle Name:JOHANNES
Last Name:SOPLER
Suffix:
Gender:M
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:4420 HOTEL CIRCLE CT
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3411
Mailing Address - Country:US
Mailing Address - Phone:619-299-8351
Mailing Address - Fax:619-299-8351
Practice Address - Street 1:4420 HOTEL CIRCLE CT
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3411
Practice Address - Country:US
Practice Address - Phone:619-299-8351
Practice Address - Fax:619-299-8351
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 1192171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist