Provider Demographics
NPI:1184603482
Name:SOPPE, MICHAEL J I (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:SOPPE
Suffix:I
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 1:1420 N US HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-3344
Mailing Address - Country:US
Mailing Address - Phone:712-792-6026
Mailing Address - Fax:712-792-6027
Practice Address - Street 1:1420 N US HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3344
Practice Address - Country:US
Practice Address - Phone:712-792-6026
Practice Address - Fax:712-792-6027
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA57582OtherBLUE CROSS PROVIDER #
IA1148031Medicaid
IA1148031Medicaid