Provider Demographics
NPI:1639254733
Name:VERNON FAMILY CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:VERNON FAMILY CHIROPRACTIC INC.
Other - Org Name:NON SURGICAL SPINE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:VERNON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-484-3472
Mailing Address - Street 1:1811 SANTA RITA RD STE 118
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4741
Mailing Address - Country:US
Mailing Address - Phone:925-484-3472
Mailing Address - Fax:925-484-1889
Practice Address - Street 1:1811 SANTA RITA RD STE 118
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4741
Practice Address - Country:US
Practice Address - Phone:925-484-3472
Practice Address - Fax:925-484-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 25817111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0258170OtherBLUESHIELD IDENTIFIER
CADC0258170Medicare PIN