Provider Demographics
NPI:1427747385
Name:SOPOTNICK, JESSICA LYNNE (DC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:SOPOTNICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 CORACI BLVD APT 1206
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-7567
Mailing Address - Country:US
Mailing Address - Phone:810-335-0085
Mailing Address - Fax:810-335-0085
Practice Address - Street 1:1301 BEVILLE RD STE 6
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32119-1503
Practice Address - Country:US
Practice Address - Phone:386-322-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor