Provider Demographics
NPI:1053592287
Name:VERNON, RONALD R (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:R
Last Name:VERNON
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 1:1811 SANTA RITA RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4746
Mailing Address - Country:US
Mailing Address - Phone:925-484-3472
Mailing Address - Fax:925-484-1889
Practice Address - Street 1:1811 SANTA RITA RD
Practice Address - Street 2:SUITE 118
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4746
Practice Address - Country:US
Practice Address - Phone:925-484-3472
Practice Address - Fax:925-484-1889
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0258170Medicare PIN
CAU74278Medicare UPIN