Healthcare Provider Details

I. General information

NPI: 1659514099
Provider Name (Legal Business Name): ROGER VERNO D C PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 E CYPRESS CREEK RD
FT LAUDERDALE FL
33334-4116
US

IV. Provider business mailing address

919 E CYPRESS CREEK RD
FT LAUDERDALE FL
33334-4116
US

V. Phone/Fax

Practice location:
  • Phone: 954-325-7168
  • Fax: 954-491-4956
Mailing address:
  • Phone: 954-325-7168
  • Fax: 954-491-4956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5059
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number9851
License Number StateFL

VIII. Authorized Official

Name: ROGER ROBERT VERNO
Title or Position: OWNER
Credential: D.C.
Phone: 954-325-7168