Provider Demographics
NPI:1982890810
Name:OPP FAMILY CHIROPRACTIC P.A.
Entity Type:Organization
Organization Name:OPP FAMILY CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JEREMY
Authorized Official - Last Name:OPP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-213-0615
Mailing Address - Street 1:23168 SAINT FRANCIS BLVD NW
Mailing Address - Street 2:#600
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:MN
Mailing Address - Zip Code:55070-9805
Mailing Address - Country:US
Mailing Address - Phone:763-213-0615
Mailing Address - Fax:763-213-0616
Practice Address - Street 1:23168 SAINT FRANCIS BLVD NW
Practice Address - Street 2:#600
Practice Address - City:SAINT FRANCIS
Practice Address - State:MN
Practice Address - Zip Code:55070-9805
Practice Address - Country:US
Practice Address - Phone:763-213-0615
Practice Address - Fax:763-213-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN744450800Medicaid
MN652617900Medicaid