Provider Demographics
NPI:1891236139
Name:VERMEULEN, CHAD ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ALAN
Last Name:VERMEULEN
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 1:245 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2337
Mailing Address - Country:US
Mailing Address - Phone:605-770-6894
Mailing Address - Fax:
Practice Address - Street 1:920 S MILLEDGE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1334
Practice Address - Country:US
Practice Address - Phone:706-546-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1310111N00000X
GACH10421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1891236139OtherBLUE CROSS BLUE SHIELD OF GEORGIA, MEDICARE, UNITEDHEALTHCARE, CIGNA