Provider Demographics
NPI:1104933894
Name:VERNALLIS, LAURA R (DC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:R
Last Name:VERNALLIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 VINEYARD RD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1726
Mailing Address - Country:US
Mailing Address - Phone:440-409-0909
Mailing Address - Fax:440-409-0910
Practice Address - Street 1:20525 CENTER RIDGE RD
Practice Address - Street 2:SUITE 148
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3437
Practice Address - Country:US
Practice Address - Phone:440-409-0909
Practice Address - Fax:440-409-0910
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3750111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition