Healthcare Provider Details

I. General information

NPI: 1366453375
Provider Name (Legal Business Name): PATRICK JOHNNY OPACHICH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 BLANDING BLVD
JACKSONVILLE FL
32210-1804
US

IV. Provider business mailing address

1610 BLANDING BLVD
JACKSONVILLE FL
32210-1804
US

V. Phone/Fax

Practice location:
  • Phone: 904-387-4151
  • Fax: 904-389-8864
Mailing address:
  • Phone: 904-387-4151
  • Fax: 904-389-8864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH0004041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: