Healthcare Provider Details

I. General information

NPI: 1699067041
Provider Name (Legal Business Name): PATRICK J. OPACHICH, D.C.P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
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 TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH4041
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK JOHNNY OPACHICH
Title or Position: PRESIDENT
Credential: D.C.
Phone: 904-387-4151