Provider Demographics
NPI:1558415422
Name:VERNON, GARY G (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:G
Last Name:VERNON
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 1:1111 N RODNEY ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3514
Mailing Address - Country:US
Mailing Address - Phone:406-495-1222
Mailing Address - Fax:406-495-1333
Practice Address - Street 1:1111 N RODNEY ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3514
Practice Address - Country:US
Practice Address - Phone:406-495-1222
Practice Address - Fax:406-495-1333
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor