1740049774 NPI number — NICHOLAS CHARLES CHOPPA MSOM, LAC, LMT

Table of content: NICHOLAS CHARLES CHOPPA MSOM, LAC, LMT (NPI 1740049774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740049774 NPI number — NICHOLAS CHARLES CHOPPA MSOM, LAC, LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOPPA
Provider First Name:
NICHOLAS
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSOM, LAC, LMT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740049774
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2225 DRAKE AVE SW STE 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35805-5126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-716-4048
Provider Business Mailing Address Fax Number:
256-489-1450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2225 DRAKE AVE SW STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35805-5126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-716-4048
Provider Business Practice Location Address Fax Number:
256-489-1450
Provider Enumeration Date:
03/13/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  4939 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X , with the licence number: 365 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)