Provider Demographics
NPI:1336667492
Name:OPDAHL CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:OPDAHL CHIROPRACTIC, P.A.
Other - Org Name:OPDAHL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:OPDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-321-1700
Mailing Address - Street 1:551 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-2105
Mailing Address - Country:US
Mailing Address - Phone:320-321-1700
Mailing Address - Fax:320-321-1515
Practice Address - Street 1:551 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-2105
Practice Address - Country:US
Practice Address - Phone:320-321-1700
Practice Address - Fax:320-321-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty