Healthcare Provider Details

I. General information

NPI: 1750529970
Provider Name (Legal Business Name): JAMES ALLEN OPSAL JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 N COLUMBIA AVE
OGLESBY IL
61348-1495
US

IV. Provider business mailing address

275 N COLUMBIA AVE
OGLESBY IL
61348-1495
US

V. Phone/Fax

Practice location:
  • Phone: 815-883-3385
  • Fax: 815-883-3386
Mailing address:
  • Phone: 815-883-3385
  • Fax: 815-883-3386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.010838
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: