Healthcare Provider Details

I. General information

NPI: 1861858805
Provider Name (Legal Business Name): KERSTIN OPITZ D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 STAMPEDE AVE
CODY WY
82414-4829
US

IV. Provider business mailing address

1708 STAMPEDE AVE
CODY WY
82414-4829
US

V. Phone/Fax

Practice location:
  • Phone: 307-587-5591
  • Fax:
Mailing address:
  • Phone: 307-587-5591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number756
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: