Provider Demographics
NPI:1356721997
Name:SOPHIA GRACE HOLDING CO.
Entity type:Organization
Organization Name:SOPHIA GRACE HOLDING CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-916-8192
Mailing Address - Street 1:7917 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:STEWARTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17363-7905
Mailing Address - Country:US
Mailing Address - Phone:717-916-8192
Mailing Address - Fax:410-728-3624
Practice Address - Street 1:7917 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:STEWARTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17363-7905
Practice Address - Country:US
Practice Address - Phone:717-916-8192
Practice Address - Fax:410-728-3624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC550092L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty