Provider Demographics
NPI:1255442729
Name:SOBOROWICZ, JOHN F (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:SOBOROWICZ
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 1:3521 LONDON RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7861
Mailing Address - Country:US
Mailing Address - Phone:715-834-6333
Mailing Address - Fax:715-831-6374
Practice Address - Street 1:3521 LONDON RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7861
Practice Address - Country:US
Practice Address - Phone:715-834-6333
Practice Address - Fax:715-831-6374
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI350050961OtherRAILROAD MEDICARE
WI350050961OtherRAILROAD MEDICARE
WIU53609Medicare UPIN