Provider Demographics
NPI:1598760696
Name:VERNON, LEONARD FRANKLIN (DC)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:FRANKLIN
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 1:813 E GATE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1238
Mailing Address - Country:US
Mailing Address - Phone:856-222-1322
Mailing Address - Fax:856-222-9632
Practice Address - Street 1:813 E GATE DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1238
Practice Address - Country:US
Practice Address - Phone:856-222-1322
Practice Address - Fax:856-222-9632
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2008-08-21
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NJMC01755111N00000X
DEF10000166111N00000X
PADC006478R111N00000X
SC2759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT73275Medicaid
NJ031566YN0Medicare UPIN