Provider Demographics
NPI:1003901927
Name:HAINEY, OPIE JACE (DC)
Entity Type:Individual
Prefix:DR
First Name:OPIE
Middle Name:JACE
Last Name:HAINEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 E MAIN ST
Mailing Address - Street 2:STE 200
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3772
Mailing Address - Country:US
Mailing Address - Phone:970-565-6776
Mailing Address - Fax:888-531-5844
Practice Address - Street 1:343 E MAIN ST
Practice Address - Street 2:STE 200
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3772
Practice Address - Country:US
Practice Address - Phone:970-565-6776
Practice Address - Fax:888-531-5844
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT97037Medicare UPIN
CO800142Medicare ID - Type Unspecified