Provider Demographics
NPI:1366453375
Name:OPACHICH, PATRICK JOHNNY (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOHNNY
Last Name:OPACHICH
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 1:1610 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1804
Mailing Address - Country:US
Mailing Address - Phone:904-387-4151
Mailing Address - Fax:904-389-8864
Practice Address - Street 1:1610 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-1804
Practice Address - Country:US
Practice Address - Phone:904-387-4151
Practice Address - Fax:904-389-8864
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004041111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88857Medicare ID - Type Unspecified
T55998Medicare UPIN