=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770891772
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERNER CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2010
-----------------------------------------------------
Last Update Date | 09/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 504 E 2ND ST
-----------------------------------------------------
City | WINNEMUCCA
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89445-2827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-623-3938
-----------------------------------------------------
Fax | 775-623-3939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 504 E 2ND ST
-----------------------------------------------------
City | WINNEMUCCA
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89445-2827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-623-3938
-----------------------------------------------------
Fax | 775-623-3939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DENNIS P VERNER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 775-623-3938
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | B00242
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------