Provider Demographics
NPI:1184610321
Name:OPP, BRIAN JEREMY (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JEREMY
Last Name:OPP
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 1:4111 232ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:ST FRANCIS
Mailing Address - State:MN
Mailing Address - Zip Code:55070-8778
Mailing Address - Country:US
Mailing Address - Phone:763-753-7339
Mailing Address - Fax:
Practice Address - Street 1:23168 SAINT FRANCIS BLVD NW
Practice Address - Street 2:SUITE 600
Practice Address - City:ST 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
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN644R8OPOtherBCBS
MN644R8OPOtherBCBS