Provider Demographics
NPI:1386618320
Name:OPET, ROBERT MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:OPET
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 1:173 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LUZERNE
Mailing Address - State:PA
Mailing Address - Zip Code:18709
Mailing Address - Country:US
Mailing Address - Phone:570-288-2262
Mailing Address - Fax:
Practice Address - Street 1:173 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1244
Practice Address - Country:US
Practice Address - Phone:570-288-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01555181Medicaid
PA806042OtherBC NEPA 1ST PRIORITY
PA806042OtherBC NEPA 1ST PRIORITY
PA806042OtherBC NEPA 1ST PRIORITY