Healthcare Provider Details

I. General information

NPI: 1700223765
Provider Name (Legal Business Name): ROGER R. VERNO, D.C.P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 10TH AVE N
LAKE WORTH FL
33461-3128
US

IV. Provider business mailing address

2407 10TH AVE N
LAKE WORTH FL
33461-3128
US

V. Phone/Fax

Practice location:
  • Phone: 562-432-6786
  • Fax:
Mailing address:
  • Phone: 562-432-6786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH5059
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberFL1169282
License Number StateFL

VIII. Authorized Official

Name: DR. ROGER ROBERT VERNO
Title or Position: OWNER
Credential: D.C.
Phone: 561-432-6786