Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3204 | CO |
NPI | 1003901927 |
---|---|
Provider Name | Dr. Opie Jace Hainey |
First Address | Cortez, CO 81321-3772 |
Second Address | Cortez, CO 81321-3772 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 11/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T97037 | (02) | CO |