Provider Demographics
NPI:1255357141
Name:BRYDER, VERNON MILES (DC)
Entity type:Individual
Prefix:MR
First Name:VERNON
Middle Name:MILES
Last Name:BRYDER
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 1:105 WEST 7TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110
Mailing Address - Country:US
Mailing Address - Phone:903-872-9122
Mailing Address - Fax:903-872-9071
Practice Address - Street 1:105 WEST 7TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110
Practice Address - Country:US
Practice Address - Phone:908-872-9122
Practice Address - Fax:908-872-9071
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
602046OtherBCBS
5010Medicare UPIN
602046Medicare ID - Type Unspecified