Healthcare Provider Details

I. General information

NPI: 1023515178
Provider Name (Legal Business Name): CHAD M OPSAL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 GULF SHORE BLVD N STE 134
NAPLES FL
34102-4971
US

IV. Provider business mailing address

1400 GULF SHORE BLVD N STE 134
NAPLES FL
34102-4971
US

V. Phone/Fax

Practice location:
  • Phone: 239-778-8114
  • Fax:
Mailing address:
  • Phone: 239-778-8114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH12392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: