Provider Demographics
NPI:1336100437
Name:OPIE, DOUGLAS (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:OPIE
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 1:110 S MESA DR
Mailing Address - Street 2:#4
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-1458
Mailing Address - Country:US
Mailing Address - Phone:480-833-8863
Mailing Address - Fax:480-464-5516
Practice Address - Street 1:110 S MESA DR
Practice Address - Street 2:#4
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-1458
Practice Address - Country:US
Practice Address - Phone:480-833-8863
Practice Address - Fax:480-464-5516
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAY4433OtherHEALTH NET
AZAZ00082250OtherAZ BLUE SHIELD
AZ543919001Medicaid
AZAY4433OtherHEALTH NET
AZ543919001Medicaid