Provider Demographics
NPI:1619189701
Name:DAMMANN, SOPHIA HAWKER (DC)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:HAWKER
Last Name:DAMMANN
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 1:1354 HORNBLEND ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4227
Mailing Address - Country:US
Mailing Address - Phone:619-549-5321
Mailing Address - Fax:
Practice Address - Street 1:460 OLIVE ST
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6218
Practice Address - Country:US
Practice Address - Phone:619-549-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 30214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor