Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 3749 | OH |
NPI | 1598872202 |
---|---|
Provider Name | Dr. Bradley M Vernallis |
First Address | Avon Lake, OH 44012-1726 |
Second Address | Avon Lake, OH 44012-1496 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 28/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4193071 | (02) | OH |