Provider Demographics
NPI:1740049774
Name:CHOPPA, NICHOLAS CHARLES (MSOM, LAC, LMT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:CHARLES
Last Name:CHOPPA
Suffix:
Gender:M
Credentials:MSOM, LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 DRAKE AVE SW STE 4
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-5126
Mailing Address - Country:US
Mailing Address - Phone:256-716-4048
Mailing Address - Fax:256-489-1450
Practice Address - Street 1:2225 DRAKE AVE SW STE 4
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-5126
Practice Address - Country:US
Practice Address - Phone:256-716-4048
Practice Address - Fax:256-489-1450
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4939225700000X
TN365171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist