Provider Demographics
NPI:1184191025
Name:VERDIER, CHAD
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:VERDIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5844 COUNTY ROAD 260
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:MO
Mailing Address - Zip Code:63461-3528
Mailing Address - Country:US
Mailing Address - Phone:573-795-2966
Mailing Address - Fax:
Practice Address - Street 1:100 E NORMAL AVE
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4221
Practice Address - Country:US
Practice Address - Phone:573-795-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program