Provider Demographics
NPI:1124056825
Name:TEMPLE, VERNON R (DC)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:R
Last Name:TEMPLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:633 ROUTE 121
Mailing Address - Street 2:102 SAXTONS RIVER RD
Mailing Address - City:BELLOWS FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05101-1632
Mailing Address - Country:US
Mailing Address - Phone:802-463-9522
Mailing Address - Fax:802-463-1957
Practice Address - Street 1:102 SAXTONS RIVER ROAD
Practice Address - Street 2:
Practice Address - City:BELLOWS FALLS
Practice Address - State:VT
Practice Address - Zip Code:05101
Practice Address - Country:US
Practice Address - Phone:802-463-9522
Practice Address - Fax:802-463-1957
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0000655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0008772Medicaid
VTVT8772Medicare ID - Type Unspecified
VTT86679Medicare UPIN