Provider Demographics
NPI:1699067041
Name:PATRICK J. OPACHICH, D.C.P.A.
Entity type:Organization
Organization Name:PATRICK J. OPACHICH, D.C.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOHNNY
Authorized Official - Last Name:OPACHICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-387-4151
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATRICK J. OPACHICH, D.C.P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-04
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4041111NX0800X
111NX0800X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381306100Medicaid
FL381306100Medicaid