Provider Demographics
NPI:1659514099
Name:ROGER VERNO D C PA
Entity Type:Organization
Organization Name:ROGER VERNO D C PA
Other - Org Name:CYPRESS CREEK CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:VERNO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-325-7168
Mailing Address - Street 1:919 E CYPRESS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4116
Mailing Address - Country:US
Mailing Address - Phone:954-325-7168
Mailing Address - Fax:954-491-4956
Practice Address - Street 1:919 E CYPRESS CREEK RD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-4116
Practice Address - Country:US
Practice Address - Phone:954-325-7168
Practice Address - Fax:954-491-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5059111N00000X
207Q00000X
FL9851208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty