Provider Demographics
NPI:1548518061
Name:VERG CMT
Entity type:Organization
Organization Name:VERG CMT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANATOLIY
Authorized Official - Middle Name:P
Authorized Official - Last Name:VERGULYANETS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-877-3435
Mailing Address - Street 1:10001 SE SUNNYSIDE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9728
Mailing Address - Country:US
Mailing Address - Phone:503-877-3435
Mailing Address - Fax:
Practice Address - Street 1:10001 SE SUNNYSIDE RD STE 120
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9728
Practice Address - Country:US
Practice Address - Phone:503-877-3435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty