Provider Demographics
NPI:1598866584
Name:OPDAHL, BRETT ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ALAN
Last Name:OPDAHL
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 1:551 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
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831132687OtherACH/CHIROCARE
MN1831132687OtherHEALTH SERVICES MANAGEMENT
MN1831132687OtherMEDICA
MN350053745OtherMEDICARE RAILROAD NUMBER
MN44113COOtherBLUE CROSS/BLUE SHIELD
MN4C515OtherMPIN
MN624807100OtherMINNESOTA CARE NUMBER
MN44113COOtherBLUE CROSS/BLUE SHIELD
MN350004985Medicare PIN