Individual provider Active NPI

Brandon Vernon, D.C.

  • Chiropractor
  • Ithaca, NY
National Provider Identifier
1972163574
Registry record updated Jun 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
013259 Issued in NY
Practice address
2415 N Triphammer Rd
Ithaca, NY 14850-1093
Phone
(607) 257-9355
NPI assigned
Jun 17, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 17, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 013259 NY Primary

Addresses

Primary practice location

2415 N Triphammer Rd
Ithaca, NY 14850-1093

Mailing address

27 Sunnyfield Dr
Cortland, NY 13045-8874
Phone (714) 330-0123

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
013259NYMDChiropractor
10346GAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Johnson Clinic of Chiropractic P.C. CurrentSince Apr 6, 2020 Accepting new patients
Molino Physical Therapy, PLLC PastSince Sep 12, 2001 Accepting new patients
Bartholomew Family Chiropractic, LLC Chiropractor PastSince Oct 1, 2009 Accepting new patients

Locations

955 Battlefield Pkwy
Ft Oglethorpe, GA 30742
Phone (706) 866-7575

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560729600000",
    "number": "1972163574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 SUNNYFIELD DR",
            "city": "CORTLAND",
            "state": "NY",
            "postal_code": "130458874",
            "telephone_number": "714-330-0123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 N TRIPHAMMER RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501093",
            "telephone_number": "607-257-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERNON",
        "first_name": "BRANDON",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-17",
        "last_updated": "2019-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "013259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ithaca, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.