Healthcare Provider Details

I. General information

NPI: 1093733313
Provider Name (Legal Business Name): ROGER ROBERT VERNO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 NE 62ND ST
FT LAUDERDALE FL
33334-4116
US

IV. Provider business mailing address

919 NE 62ND ST
FT LAUDERDALE FL
33334-4116
US

V. Phone/Fax

Practice location:
  • Phone: 954-491-3472
  • Fax: 954-491-4956
Mailing address:
  • Phone: 954-491-3472
  • Fax: 954-491-4956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5059
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: