Provider Demographics
NPI:1487912291
Name:VERGULYANETS, ANATOLIY (DC)
Entity type:Individual
Prefix:DR
First Name:ANATOLIY
Middle Name:
Last Name:VERGULYANETS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SE CHKALOV DR STE 111-302
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5292
Mailing Address - Country:US
Mailing Address - Phone:360-553-1050
Mailing Address - Fax:503-200-2980
Practice Address - Street 1:109 SE 101ST AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3907
Practice Address - Country:US
Practice Address - Phone:360-553-1050
Practice Address - Fax:503-200-2980
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5048111N00000X
WACH 60275801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor