Provider Demographics
NPI:1619057627
Name:SOFIA, MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SOFIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:25 MARSTON ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2310
Mailing Address - Country:US
Mailing Address - Phone:978-687-7117
Mailing Address - Fax:978-687-7417
Practice Address - Street 1:25 MARSTON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2310
Practice Address - Country:US
Practice Address - Phone:978-687-7117
Practice Address - Fax:978-687-7417
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1610562Medicaid
MA1610562Medicaid
U56849Medicare UPIN