Provider Demographics
NPI:1528172525
Name:YORK, VERNON LEON JR (DC)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:LEON
Last Name:YORK
Suffix:JR
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 1:8039 S 54TH DR
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2856
Mailing Address - Country:US
Mailing Address - Phone:602-237-1304
Mailing Address - Fax:
Practice Address - Street 1:6750 W OLIVE AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-8888
Practice Address - Country:US
Practice Address - Phone:623-937-6151
Practice Address - Fax:623-979-7097
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0423120OtherBCBS IDENTIFIER
AZAZ0423120OtherBCBS IDENTIFIER