Provider Demographics
NPI:1134315781
Name:OPDAHL CHIROPRACTIC OFFICE INC.
Entity Type:Organization
Organization Name:OPDAHL CHIROPRACTIC OFFICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:OPDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-666-6001
Mailing Address - Street 1:105 N PARKWAY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9129
Mailing Address - Country:US
Mailing Address - Phone:360-666-6001
Mailing Address - Fax:360-666-6002
Practice Address - Street 1:105 N PARKWAY AVE STE 101
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9129
Practice Address - Country:US
Practice Address - Phone:360-666-6001
Practice Address - Fax:360-666-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8803583Medicare PIN