Provider Demographics
NPI:1689636912
Name:SOPCAK, STEVEN ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ANTHONY
Last Name:SOPCAK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 W UNIVERSITY PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1617
Mailing Address - Country:US
Mailing Address - Phone:731-664-5681
Mailing Address - Fax:731-664-5393
Practice Address - Street 1:156 W UNIVERSITY PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1617
Practice Address - Country:US
Practice Address - Phone:731-664-5681
Practice Address - Fax:731-664-5393
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC00622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3674660Medicare ID - Type Unspecified
TNT74692Medicare UPIN