Provider Demographics
NPI:1598872202
Name:VERNALLIS, BRADLEY M (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:M
Last Name:VERNALLIS
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 1:120 VINEYARD RD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1726
Mailing Address - Country:US
Mailing Address - Phone:440-409-0909
Mailing Address - Fax:440-409-0910
Practice Address - Street 1:33398 WALKER RD D
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1496
Practice Address - Country:US
Practice Address - Phone:440-653-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3749111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4193071Medicare UPIN