Provider Demographics
NPI:1083156608
Name:WALDORF, VERNON THOMAS JR (DC)
Entity Type:Individual
Prefix:MR
First Name:VERNON
Middle Name:THOMAS
Last Name:WALDORF
Suffix:JR
Gender:M
Credentials:DC
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Mailing Address - Street 1:4790 CAUGHLIN PKWY # 163
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-0907
Mailing Address - Country:US
Mailing Address - Phone:775-842-0065
Mailing Address - Fax:775-473-3268
Practice Address - Street 1:6135 LAKESIDE DR STE 119
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511
Practice Address - Country:US
Practice Address - Phone:775-842-0065
Practice Address - Fax:775-473-3268
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2018-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVB01545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor