Provider Demographics
NPI:1689649139
Name:SOVA, J WILLIAM (DCBS)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:WILLIAM
Last Name:SOVA
Suffix:
Gender:M
Credentials:DCBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 RED DEER RD
Mailing Address - Street 2:
Mailing Address - City:FRANKTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80116-8733
Mailing Address - Country:US
Mailing Address - Phone:303-308-0241
Mailing Address - Fax:303-308-0241
Practice Address - Street 1:236 RED DEER RD
Practice Address - Street 2:
Practice Address - City:FRANKTOWN
Practice Address - State:CO
Practice Address - Zip Code:80116-8733
Practice Address - Country:US
Practice Address - Phone:303-308-0241
Practice Address - Fax:303-308-0241
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08023038Medicaid
COC44563Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
COU26672Medicare UPIN