Provider Demographics
NPI:1710996533
Name:POPOVICS, DAMON JOSEF (DC)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:JOSEF
Last Name:POPOVICS
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 1:830 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-7005
Mailing Address - Country:US
Mailing Address - Phone:208-476-7091
Mailing Address - Fax:866-993-2828
Practice Address - Street 1:830 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-7005
Practice Address - Country:US
Practice Address - Phone:208-476-7091
Practice Address - Fax:866-993-2828
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1515111N00000X
CA28525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor